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Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry

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Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry. / Kaesmacher, Johannes; Abdullayev, Nuran; Maamari, Basel; Dobrocky, Tomas; Vynckier, Jan; Piechowiak, Eike I; Pop, Raoul; Behme, Daniel; Sporns, Peter B; Styczen, Hanna; Virtanen, Pekka; Meyer, Lukas; Meinel, Thomas R; Cantré, Daniel; Kabbasch, Christoph; Maus, Volker; Pekkola, Johanna; Fischer, Sebastian; Hasiu, Anca; Schwarz, Alexander; Wildgruber, Moritz; Seiffge, David J; Langner, Sönke; Martinez-Majander, Nicolas; Radbruch, Alexander; Schlamann, Marc; Mihoc, Dan; Beaujeux, Rémy; Strbian, Daniel; Fiehler, Jens; Mordasini, Pasquale; Gralla, Jan; Fischer, Urs.

in: J STROKE, Jahrgang 23, Nr. 1, 01.2021, S. 91-102.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Kaesmacher, J, Abdullayev, N, Maamari, B, Dobrocky, T, Vynckier, J, Piechowiak, EI, Pop, R, Behme, D, Sporns, PB, Styczen, H, Virtanen, P, Meyer, L, Meinel, TR, Cantré, D, Kabbasch, C, Maus, V, Pekkola, J, Fischer, S, Hasiu, A, Schwarz, A, Wildgruber, M, Seiffge, DJ, Langner, S, Martinez-Majander, N, Radbruch, A, Schlamann, M, Mihoc, D, Beaujeux, R, Strbian, D, Fiehler, J, Mordasini, P, Gralla, J & Fischer, U 2021, 'Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry', J STROKE, Jg. 23, Nr. 1, S. 91-102. https://doi.org/10.5853/jos.2020.01788

APA

Kaesmacher, J., Abdullayev, N., Maamari, B., Dobrocky, T., Vynckier, J., Piechowiak, E. I., Pop, R., Behme, D., Sporns, P. B., Styczen, H., Virtanen, P., Meyer, L., Meinel, T. R., Cantré, D., Kabbasch, C., Maus, V., Pekkola, J., Fischer, S., Hasiu, A., ... Fischer, U. (2021). Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry. J STROKE, 23(1), 91-102. https://doi.org/10.5853/jos.2020.01788

Vancouver

Kaesmacher J, Abdullayev N, Maamari B, Dobrocky T, Vynckier J, Piechowiak EI et al. Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry. J STROKE. 2021 Jan;23(1):91-102. https://doi.org/10.5853/jos.2020.01788

Bibtex

@article{c3250ecb23f449709e5b89851a4e7932,
title = "Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry",
abstract = "BACKGROUND AND PURPOSE: Data on safety and efficacy of intra-arterial (IA) fibrinolytics as adjunct to mechanical thrombectomy (MT) are sparse.METHODS: INtra-arterial FIbriNolytics In ThrombectomY (INFINITY) is a retrospective multi-center observational registry of consecutive patients with anterior circulation large-vessel occlusion ischemic stroke treated with MT and adjunctive administration of IA fibrinolytics (alteplase [tissue plasminogen activator, tPA] or urokinase [UK]) at 10 European centers. Primary outcome was the occurrence of symptomatic intracranial hemorrhage (sICH) according to the European Cooperative Acute Stroke Study II definition. Secondary outcomes were mortality and modified Rankin Scale (mRS) scores at 3 months.RESULTS: Of 5,612 patients screened, 311 (median age, 74 years; 44.1% female) received additional IA after or during MT (194 MT+IA tPA, 117 MT+IA UK). IA fibrinolytics were mostly administered for rescue of thrombolysis in cerebral infarction (TICI) 0-2b after MT (80.4%, 250/311). sICH occurred in 27 of 308 patients (8.8%), with an increased risk in patients with initial TICI0/1 (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1 to 5.0 per TICI grade decrease) or in those with intracranial internal carotid artery occlusions (aOR, 3.7; 95% CI, 1.2 to 12.5). In patients with attempted rescue of TICI0-2b and available angiographic follow-up, 116 of 228 patients (50.9%) showed any angiographic reperfusion improvement after IA fibrinolytics, which was associated with mRS ≤2 (aOR, 3.1; 95% CI, 1.4 to 6.9).CONCLUSIONS: Administration of IA fibrinolytics as adjunct to MT is performed rarely, but can improve reperfusion, which is associated with better outcomes. Despite a selection bias, an increased risk of sICH seems possible, which underlines the importance of careful patient selection.",
author = "Johannes Kaesmacher and Nuran Abdullayev and Basel Maamari and Tomas Dobrocky and Jan Vynckier and Piechowiak, {Eike I} and Raoul Pop and Daniel Behme and Sporns, {Peter B} and Hanna Styczen and Pekka Virtanen and Lukas Meyer and Meinel, {Thomas R} and Daniel Cantr{\'e} and Christoph Kabbasch and Volker Maus and Johanna Pekkola and Sebastian Fischer and Anca Hasiu and Alexander Schwarz and Moritz Wildgruber and Seiffge, {David J} and S{\"o}nke Langner and Nicolas Martinez-Majander and Alexander Radbruch and Marc Schlamann and Dan Mihoc and R{\'e}my Beaujeux and Daniel Strbian and Jens Fiehler and Pasquale Mordasini and Jan Gralla and Urs Fischer",
year = "2021",
month = jan,
doi = "10.5853/jos.2020.01788",
language = "English",
volume = "23",
pages = "91--102",
journal = "J STROKE",
issn = "2287-6391",
publisher = "Korean Stroke Society",
number = "1",

}

RIS

TY - JOUR

T1 - Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry

AU - Kaesmacher, Johannes

AU - Abdullayev, Nuran

AU - Maamari, Basel

AU - Dobrocky, Tomas

AU - Vynckier, Jan

AU - Piechowiak, Eike I

AU - Pop, Raoul

AU - Behme, Daniel

AU - Sporns, Peter B

AU - Styczen, Hanna

AU - Virtanen, Pekka

AU - Meyer, Lukas

AU - Meinel, Thomas R

AU - Cantré, Daniel

AU - Kabbasch, Christoph

AU - Maus, Volker

AU - Pekkola, Johanna

AU - Fischer, Sebastian

AU - Hasiu, Anca

AU - Schwarz, Alexander

AU - Wildgruber, Moritz

AU - Seiffge, David J

AU - Langner, Sönke

AU - Martinez-Majander, Nicolas

AU - Radbruch, Alexander

AU - Schlamann, Marc

AU - Mihoc, Dan

AU - Beaujeux, Rémy

AU - Strbian, Daniel

AU - Fiehler, Jens

AU - Mordasini, Pasquale

AU - Gralla, Jan

AU - Fischer, Urs

PY - 2021/1

Y1 - 2021/1

N2 - BACKGROUND AND PURPOSE: Data on safety and efficacy of intra-arterial (IA) fibrinolytics as adjunct to mechanical thrombectomy (MT) are sparse.METHODS: INtra-arterial FIbriNolytics In ThrombectomY (INFINITY) is a retrospective multi-center observational registry of consecutive patients with anterior circulation large-vessel occlusion ischemic stroke treated with MT and adjunctive administration of IA fibrinolytics (alteplase [tissue plasminogen activator, tPA] or urokinase [UK]) at 10 European centers. Primary outcome was the occurrence of symptomatic intracranial hemorrhage (sICH) according to the European Cooperative Acute Stroke Study II definition. Secondary outcomes were mortality and modified Rankin Scale (mRS) scores at 3 months.RESULTS: Of 5,612 patients screened, 311 (median age, 74 years; 44.1% female) received additional IA after or during MT (194 MT+IA tPA, 117 MT+IA UK). IA fibrinolytics were mostly administered for rescue of thrombolysis in cerebral infarction (TICI) 0-2b after MT (80.4%, 250/311). sICH occurred in 27 of 308 patients (8.8%), with an increased risk in patients with initial TICI0/1 (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1 to 5.0 per TICI grade decrease) or in those with intracranial internal carotid artery occlusions (aOR, 3.7; 95% CI, 1.2 to 12.5). In patients with attempted rescue of TICI0-2b and available angiographic follow-up, 116 of 228 patients (50.9%) showed any angiographic reperfusion improvement after IA fibrinolytics, which was associated with mRS ≤2 (aOR, 3.1; 95% CI, 1.4 to 6.9).CONCLUSIONS: Administration of IA fibrinolytics as adjunct to MT is performed rarely, but can improve reperfusion, which is associated with better outcomes. Despite a selection bias, an increased risk of sICH seems possible, which underlines the importance of careful patient selection.

AB - BACKGROUND AND PURPOSE: Data on safety and efficacy of intra-arterial (IA) fibrinolytics as adjunct to mechanical thrombectomy (MT) are sparse.METHODS: INtra-arterial FIbriNolytics In ThrombectomY (INFINITY) is a retrospective multi-center observational registry of consecutive patients with anterior circulation large-vessel occlusion ischemic stroke treated with MT and adjunctive administration of IA fibrinolytics (alteplase [tissue plasminogen activator, tPA] or urokinase [UK]) at 10 European centers. Primary outcome was the occurrence of symptomatic intracranial hemorrhage (sICH) according to the European Cooperative Acute Stroke Study II definition. Secondary outcomes were mortality and modified Rankin Scale (mRS) scores at 3 months.RESULTS: Of 5,612 patients screened, 311 (median age, 74 years; 44.1% female) received additional IA after or during MT (194 MT+IA tPA, 117 MT+IA UK). IA fibrinolytics were mostly administered for rescue of thrombolysis in cerebral infarction (TICI) 0-2b after MT (80.4%, 250/311). sICH occurred in 27 of 308 patients (8.8%), with an increased risk in patients with initial TICI0/1 (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1 to 5.0 per TICI grade decrease) or in those with intracranial internal carotid artery occlusions (aOR, 3.7; 95% CI, 1.2 to 12.5). In patients with attempted rescue of TICI0-2b and available angiographic follow-up, 116 of 228 patients (50.9%) showed any angiographic reperfusion improvement after IA fibrinolytics, which was associated with mRS ≤2 (aOR, 3.1; 95% CI, 1.4 to 6.9).CONCLUSIONS: Administration of IA fibrinolytics as adjunct to MT is performed rarely, but can improve reperfusion, which is associated with better outcomes. Despite a selection bias, an increased risk of sICH seems possible, which underlines the importance of careful patient selection.

U2 - 10.5853/jos.2020.01788

DO - 10.5853/jos.2020.01788

M3 - SCORING: Journal article

C2 - 33600706

VL - 23

SP - 91

EP - 102

JO - J STROKE

JF - J STROKE

SN - 2287-6391

IS - 1

ER -