Effect of Intravenous Alteplase Treatment on First-Line Stent Retriever Versus Aspiration Alone During Endovascular Treatment. Issue 11 (25th July 2022)

• Record Type: Journal Article
• Authors: Rinkel, Leon A.; Treurniet, Kilian M.; Nieboer, Daan; Kappelhof, Manon; LeCouffe, Natalie E.; Bruggeman, Agnetha A.E.; van Zwam, Wim H.; Lycklama à Nijeholt, Geert J.; Ghariq, Elyas; Uyttenboogaart, Maarten; Dippel, Diederik W.J.; Roos, Yvo B.W.E.M.; Coutinho, Jonathan M.; Majoie, Charles B.L.M.; Emmer, Bart J.
• Other Names: Roozenbeek Bob author non-byline.; van Es Adriaan author non-byline.; de Ridder Inger author non-byline.; van der Worp Bart author non-byline.; Lo Rob author non-byline.; Keizer Koos author non-byline.; Gons Rob author non-byline.; Yo Lonneke author non-byline.; Boiten Jelis author non-byline.; van den Wijngaard Ido author non-byline.; Hofmeijer Jeanette author non-byline.; Martens Jasper author non-byline.; Schonewille Wouter author non-byline.; Albert Vos Jan author non-byline.; Tuladhar Anil author non-byline.; Schreuder Floris author non-byline.; Boogaarts Jeroen author non-byline.; Jenniskens Sjoerd author non-byline.; de Laat Karlijn author non-byline.; van Dijk Lukas author non-byline.; den Hertog Heleen author non-byline.; van Hasselt Boudewijn author non-byline.; Brouwers Paul author non-byline.; Sturm Emiel author non-byline.; Bulut Tomas author non-byline.; Remmers Michel author non-byline.; van Norden Anouk author non-byline.; de Jong Thijs author non-byline.; Rozeman Anouk author non-byline.; Elgersma Otto author non-byline.; Bokkers Reinoud author non-byline.; van Tuijl Julia author non-byline.; Boukrab Issam author non-byline.; Kortman Hans author non-byline.; Costalat Vincent author non-byline.; Arquizan Caroline author non-byline.; Lemmens Robin author non-byline.; Demeestere Jelle author non-byline.; Desfontaines Philippe author non-byline.; Brisbois Denis author non-byline.; Clarençon Frédéric author non-byline.; Samson Yves author non-byline.; van Es Adriaan author non-byline.; Boiten Jelis author non-byline.; Yo Lonneke author non-byline.; Keizer Koos author non-byline.; Brown Martin author non-byline.; White Phil author non-byline.; Gregson John author non-byline.; van Nuland Rick author non-byline.; van der Lugt Aad author non-byline.; Jacobi Linda author non-byline.; van den Berg René author non-byline.; Beenen Ludo author non-byline.; van Es Adriaan author non-byline.; van Doormaal Pieter-Jan author non-byline.; van den Wijngaard Ido author non-byline.; Yoo Albert author non-byline.; Yo Lonneke author non-byline.; Martens Jasper author non-byline.; Hammer Bas author non-byline.; Roosendaal Stefan author non-byline.; Meijer Anton author non-byline.; Krietemeijer Menno author non-byline.; Bokkers Reinoud author non-byline.; van der Hoorn Anouk author non-byline.; Gerrits Dick author non-byline.; van Oostenbrugge Robert author non-byline.; Jansen Ben author non-byline.; Manschot Sanne author non-byline.; Kerkhof Henk author non-byline.; van den Wijngaard Ido author non-byline.; Koudstaal Peter author non-byline.; Keizer Koos author non-byline.; Lingsma Hester author non-byline.; Chalos Vicky author non-byline.; Berkhemer Olvert author non-byline.; van der Lugt Aad author non-byline.; Versteeg Adriaan author non-byline.; Wolff Lennard author non-byline.; Su Jiahang author non-byline.; Tolhuisen Manon author non-byline.; van Voorst Henk author non-byline.; ten Cate Hugo author non-byline.; de Maat Moniek author non-byline.; Donse-Donkel Samantha author non-byline.; van Beusekom Heleen author non-byline.; Taha Aladdin author non-byline.; Chalos Vicky author non-byline.; van den Berg Sophie author non-byline.; van de Graaf Rob author non-byline.; Goldhoorn Robert-Jan author non-byline.; Taha Aladdin author non-byline.; Donse-Donkel Samantha author non-byline.; Hinsenveld Wouter author non-byline.; Pirson Anne author non-byline.; Sondag Lotte author non-byline.; Reinink Rik author non-byline.; Tolhuisen Manon author non-byline.; Brouwer Josje author non-byline.; Wolff Lennard author non-byline.; Collette Sabine author non-byline.; van der Steen Wouter author non-byline.; Sprengers Rita author non-byline.; Sterrenberg Martin author non-byline.; El Ghannouti Naziha author non-byline.; Verheesen Sabrina author non-byline.; Pellikaan Wilma author non-byline.; Blauwendraat Kitty author non-byline.; Drabbe Yvonne author non-byline.; de Meris Joke author non-byline.; Simons Michelle author non-byline.; Bongenaar Hester author non-byline.; van Loon Anja author non-byline.; Ponjee Eva author non-byline.; Eilander Rieke author non-byline.; Kooij Suze author non-byline.; de Jong Marieke author non-byline.; Santegoets Esther author non-byline.; Roodenburg Suze author non-byline.; van Ahee Ayla author non-byline.; Moynier Marinette author non-byline.; Devroye Annemie author non-byline.; Marcis Evelyn author non-byline.; Iezzi Ingrid author non-byline.; David Annie author non-byline.; Talbi Atika author non-byline.; Heiligers Leontien author non-byline.; Martens Yvonne author non-byline.;
• Is Part Of: Stroke. Volume 53:Issue 11(2022)
• Page Start: 3278
• Page End: 3288
• Publication Date: 2022-07-25
• Subjects: ischemic stroke -- patients -- reperfusion -- stent -- thrombectomy; Cerebrovascular disease -- Periodicals; Cerebral circulation -- Periodicals; 616.81
• DOI: 10.1161/STROKEAHA.121.038390
• Languages: English
• ISSNs: 0039-2499

Abstract

Abstract : Background: We aimed to assess whether the effect of intravenous alteplase treatment (IVT) before endovascular treatment (EVT) on outcome is modified by first-line technique during EVT in IVT eligible patients. Methods: This was a post hoc analysis from MR CLEAN-NO IV (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands - Intravenous Treatment Followed by Intra-Arterial Treatment Versus Direct Intra-Arterial Treatment for Acute Ischemic Stroke Caused by a Proximal Intracranial Occlusion), a randomized trial of IVT followed by EVT versus EVT alone in patients presenting directly to EVT-capable centers. We included data from all patients who underwent EVT with a thrombectomy attempt. We compared patients treated with stent retriever (with or without aspiration) to aspiration alone as first-line EVT technique and assessed the interaction of first-line EVT technique with IVT treatment. Primary outcome was the 90-day modified Rankin Scale score, analyzed with mixed model ordinal regression for a shift towards better outcome. Secondary outcomes included successful reperfusion (extended Thrombolysis in Cerebral Infarction score 2b–3). Results: Of 473 included patients, 102 (21.6%) were treated with aspiration alone as first-line technique. In the full population, functional outcome was similar for patients treated with stent retriever versus aspiration only (adjusted common odds ratio [acOR]‚ 1.07 [95% CI, 0.69–1.66]). We observed a significant interaction between IVT and first-line EVT technique ( P =0.03). In the aspiration-only group, patients treated with EVT alone had worse functional outcome compared to those treated with IVT and EVT (acOR, 0.44 [95% CI, 0.21–0.90]). In the stent retriever group, functional outcome did not differ between patients treated with or without IVT (acOR, 1.08 [95% CI, 0.74–1.57]). There was no statistically significant interaction for successful reperfusion. Conclusions: In MR CLEAN-NO IV, the treatment effect of IVT was modified by first-line EVT technique. Patients treated with aspiration only as first-line technique had worse clinical outcomes if they did not receive IVT. No such difference was observed in patients treated with stent retrievers. Confirmation by pooling with results from other trials is needed to confirm these findings.