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Association of intravenous thrombolysis and pre-interventional reperfusion: a post hoc analysis of the SWIFT DIRECT trial

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Název: Association of intravenous thrombolysis and pre-interventional reperfusion: a post hoc analysis of the SWIFT DIRECT trial
Autoři: Adnan Mujanovic, Omer Eker, Gaultier Marnat, Daniel Strbian, Petra Ijäs, Cécile Préterre, Aude Triquenot, Jean François Albucher, Maxime Gauberti, David Weisenburger-Lile, Marielle Ernst, Omid Nikoubashman, Anastasios Mpotsaris, Benjamin Gory, Vi Tuan Hua, Marc Ribo, David S Liebeskind, Tomas Dobrocky, Thomas R Meinel, Lukas Buetikofer, Jan Gralla, Urs Fischer, Johannes Kaesmacher
Přispěvatelé: Institut Català de la Salut, [Mujanovic A] University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern Inselspital, University of Bern, Bern, Switzerland. [Eker O] Department of Neuroradiology, Hospices Civils de Lyon, Bron, France. [Marnat G] Interventional and Diagnostic Neuroradiology, University Hospital Centre Bordeaux, Bordeaux, France. [Strbian D, Ijäs P] Department of Neurology, HUS Helsinki University Hospital, Helsinki, Finland. [Préterre C] Stroke Unit, University Hospital Centre Nantes, Nantes, France. [Ribo M] Unitat d’Ictus, Servei de Neurologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Neurologian yksikkö, HUS Neurocenter, Clinicum, Department of Neurosciences, Mujanovic, Adnan, Eker, Omer, Marnat, Gaultier, Strbian, Daniel, Ijäs, Petra, Préterre, Cécile, Triquenot, Aude, Albucher, Jean François, Gauberti, Maxime, Weisenburger-Lile, David, Kaesmacher, Johannes, Bern University Hospital Berne (Inselspital), Département de Neuroradiologie Centre Hospitalier Lyon Sud - HCL, Centre Hospitalier Lyon Sud CHU - HCL (CHLS), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Département de Neuro-Radiologie Bordeaux (DNR - Bordeaux), Centre Hospitalier Universitaire de Bordeaux (CHU Bordeaux), Helsinki University Hospital Finland (HUS), Centre Hospitalier Universitaire de Nantes = Nantes University Hospital (CHU Nantes), Service de neurologie Rouen, CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN), Normandie Université (NU), Départment de Neuroradiologie CHU Caen, Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Service de neuroradiologie Suresnes, Hôpital Foch Suresnes, University Medical Center Göttingen (UMG), Universitätsklinikum RWTH Aachen - University Hospital Aachen Aachen, Germany (UKA), RWTH Aachen University = Rheinisch-Westfälische Technische Hochschule Aachen (RWTH Aachen), University-Hospital Munich-Großhadern München, Service de neurologie CHRU Nancy, Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Service de neurologie Reims, Hôpital universitaire Robert Debré Reims (CHU Reims), Vall d'Hebron University Hospital Barcelona, Department of Neurology UCLA, University of California Los Angeles (UCLA), University of California (UC)-University of California (UC)-David Geffen School of Medicine Los Angeles, University of California (UC)-University of California (UC), Universität Bern = University of Bern = Université de Berne (UNIBE), University Hospital Basel Basel
Zdroj: J Neurointerv Surg
Scientia
Scientia. Dipòsit d'Informació Digital del Departament de Salut
instname
Mujanovic, Adnan; Eker, Omer; Marnat, Gaultier; Strbian, Daniel; Ijäs, Petra; Préterre, Cécile; Triquenot, Aude; Albucher, Jean François; Gauberti, Maxime; Weisenburger-Lile, David; Ernst, Marielle; Nikoubashman, Omid; Mpotsaris, Anastasios; Gory, Benjamin; Tuan Hua, Vi; Ribo, Marc; Liebeskind, David S; Dobrocky, Tomas; Meinel, Thomas R; Buetikofer, Lukas; ... (2023). Association of intravenous thrombolysis and pre-interventional reperfusion: a post hoc analysis of the SWIFT DIRECT trial. Journal of neurointerventional surgery, 15(e2), e232-e239. BMJ Publishing Group 10.1136/jnis-2022-019585 <http://dx.doi.org/10.1136/jnis-2022-019585>
Informace o vydavateli: BMJ, 2022.
Rok vydání: 2022
Témata: MESH: Thrombolytic Therapy / methods, Mechanical Thrombolysis, [SDV]Life Sciences [q-bio], Surgery, anesthesiology, intensive care, radiology, MESH: Fibrinolytic Agents / therapeutic use, 610 Medicine & health, MESH: Thrombectomy / methods, Brain Ischemia, 03 medical and health sciences, Vasos sanguinis - Cirurgia, 0302 clinical medicine, MESH: Brain Ischemia* / surgery, Fibrinolytic Agents, DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Stroke, MESH: Brain Ischemia* / drug therapy, Humans, Thrombolytic Therapy, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::trombólisis mecánica, MESH: Treatment Outcome, Ischemic Stroke, Thrombectomy, Randomized Controlled Trials as Topic, MESH: Humans, Neurosciences, MESH: Mechanical Thrombolysis* / methods, Thrombolysis, MESH: Reperfusion, MESH: Stroke* / diagnostic imaging, 3. Good health, Stroke, MESH: Brain Ischemia* / diagnostic imaging, MESH: Randomized Controlled Trials as Topic, ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::accidente cerebrovascular, Treatment Outcome, MESH: Ischemic Stroke* / etiology, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Thrombectomy, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Mechanical Thrombolysis, Reperfusion, Malalties cerebrovasculars - Cirurgia, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos vasculares::trombectomía, Teràpia trombolítica, MESH: Stroke* / surgery, MESH: Stroke* / drug therapy
Popis: BackgroundA potential benefit of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) is pre-interventional reperfusion. Currently, there are few data on the occurrence of pre-interventional reperfusion in patients randomized to IVT or no IVT before MT.MethodsSWIFT DIRECT (Solitaire With the Intention For Thrombectomy Plus Intravenous t-PA vs DIRECT Solitaire Stent-retriever Thrombectomy in Acute Anterior Circulation Stroke) was a randomized controlled trial including acute ischemic stroke IVT eligible patients being directly admitted to a comprehensive stroke center, with allocation to IVT with MT versus MT alone. The primary endpoint of this analysis was the occurrence of pre-interventional reperfusion, defined as a pre-interventional expanded Thrombolysis in Cerebral Infarction score of ≥2a. The effect of IVT and potential treatment effect heterogeneity were analyzed using logistic regression analyses.ResultsOf 396 patients, pre-interventional reperfusion occurred in 20 (10.0%) patients randomized to IVT with MT, and in 7 (3.6%) patients randomized to MT alone. Receiving IVT favored the occurrence of pre-interventional reperfusion (adjusted OR 2.91, 95% CI 1.23 to 6.87). There was no IVT treatment effect heterogeneity on the occurrence of pre-interventional reperfusion with different strata of Randomization-to-Groin-Puncture time (p for interaction=0.33), although the effect tended to be stronger in patients with a Randomization-to-Groin-Puncture time >28 min (adjusted OR 4.65, 95% CI 1.16 to 18.68). There were no significant differences in rates of functional outcomes between patients with and without pre-interventional reperfusion.ConclusionEven for patients with proximal large vessel occlusions and direct access to MT, IVT resulted in an absolute increase of 6% in rates of pre-interventional reperfusion. The influence of time strata on the occurrence of pre-interventional reperfusion should be studied further in an individual patient data meta-analysis of comparable trials.Trial registration numberclinicaltrials.govNCT03192332.
Druh dokumentu: Article
Other literature type
Popis souboru: application/pdf
Jazyk: English
ISSN: 1759-8486
1759-8478
DOI: 10.1136/jnis-2022-019585
DOI: 10.48350/174935
Přístupová URL adresa: https://pubmed.ncbi.nlm.nih.gov/36396433
https://hdl.handle.net/11351/10649
http://hdl.handle.net/10138/572216
https://resolver.sub.uni-goettingen.de/purl?gro-2/118128
https://boris.unibe.ch/174935/
Rights: CC BY NC
Přístupové číslo: edsair.doi.dedup.....18997dac22198e3bdacbf46a35f43eb4
Databáze: OpenAIRE
Popis
Abstrakt:BackgroundA potential benefit of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) is pre-interventional reperfusion. Currently, there are few data on the occurrence of pre-interventional reperfusion in patients randomized to IVT or no IVT before MT.MethodsSWIFT DIRECT (Solitaire With the Intention For Thrombectomy Plus Intravenous t-PA vs DIRECT Solitaire Stent-retriever Thrombectomy in Acute Anterior Circulation Stroke) was a randomized controlled trial including acute ischemic stroke IVT eligible patients being directly admitted to a comprehensive stroke center, with allocation to IVT with MT versus MT alone. The primary endpoint of this analysis was the occurrence of pre-interventional reperfusion, defined as a pre-interventional expanded Thrombolysis in Cerebral Infarction score of ≥2a. The effect of IVT and potential treatment effect heterogeneity were analyzed using logistic regression analyses.ResultsOf 396 patients, pre-interventional reperfusion occurred in 20 (10.0%) patients randomized to IVT with MT, and in 7 (3.6%) patients randomized to MT alone. Receiving IVT favored the occurrence of pre-interventional reperfusion (adjusted OR 2.91, 95% CI 1.23 to 6.87). There was no IVT treatment effect heterogeneity on the occurrence of pre-interventional reperfusion with different strata of Randomization-to-Groin-Puncture time (p for interaction=0.33), although the effect tended to be stronger in patients with a Randomization-to-Groin-Puncture time >28 min (adjusted OR 4.65, 95% CI 1.16 to 18.68). There were no significant differences in rates of functional outcomes between patients with and without pre-interventional reperfusion.ConclusionEven for patients with proximal large vessel occlusions and direct access to MT, IVT resulted in an absolute increase of 6% in rates of pre-interventional reperfusion. The influence of time strata on the occurrence of pre-interventional reperfusion should be studied further in an individual patient data meta-analysis of comparable trials.Trial registration numberclinicaltrials.govNCT03192332.
ISSN:17598486
17598478
DOI:10.1136/jnis-2022-019585