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Benefit of Intravenous Alteplase Before Thrombectomy Depends on ASPECTS

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Benefit of Intravenous Alteplase Before Thrombectomy Depends on ASPECTS. / Broocks, Gabriel; Heit, Jeremy J; Kuraitis, Gabriella M; Meyer, Lukas; van Horn, Noel; Bechstein, Matthias; Thaler, Christian; Christensen, Soren; Mlynash, Michael; Lansberg, Maarten G; Kemmling, Andre; Schön, Gerhard; Albers, Gregory; Fiehler, Jens; Wintermark, Max; Faizy, Tobias D.

In: ANN NEUROL, Vol. 92, No. 4, 10.2022, p. 588-595.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Broocks, G, Heit, JJ, Kuraitis, GM, Meyer, L, van Horn, N, Bechstein, M, Thaler, C, Christensen, S, Mlynash, M, Lansberg, MG, Kemmling, A, Schön, G, Albers, G, Fiehler, J, Wintermark, M & Faizy, TD 2022, 'Benefit of Intravenous Alteplase Before Thrombectomy Depends on ASPECTS', ANN NEUROL, vol. 92, no. 4, pp. 588-595. https://doi.org/10.1002/ana.26451

APA

Broocks, G., Heit, J. J., Kuraitis, G. M., Meyer, L., van Horn, N., Bechstein, M., Thaler, C., Christensen, S., Mlynash, M., Lansberg, M. G., Kemmling, A., Schön, G., Albers, G., Fiehler, J., Wintermark, M., & Faizy, T. D. (2022). Benefit of Intravenous Alteplase Before Thrombectomy Depends on ASPECTS. ANN NEUROL, 92(4), 588-595. https://doi.org/10.1002/ana.26451

Vancouver

Broocks G, Heit JJ, Kuraitis GM, Meyer L, van Horn N, Bechstein M et al. Benefit of Intravenous Alteplase Before Thrombectomy Depends on ASPECTS. ANN NEUROL. 2022 Oct;92(4):588-595. https://doi.org/10.1002/ana.26451

Bibtex

@article{db35169da87341c9aba891171ae3bd8d,
title = "Benefit of Intravenous Alteplase Before Thrombectomy Depends on ASPECTS",
abstract = "PURPOSE: Baseline variables could be used to guide the administration of additional intravenous alteplase (IVT) before mechanical thrombectomy (MT). The aim of this study was to determine how baseline imaging and demographic parameters modify the effect of IVT on clinical outcomes in patients with ischemic stroke due to large vessel occlusion.METHODS: Multicenter retrospective cohort study of ischemic stroke patients triaged by multimodal-CT undergoing MT treatment after direct admission to an MT-eligible center. Inverse-probability weighting analysis (IPW) was used to assess the treatment effect of IVT adjusted for baseline variables. Multivariable logistic regression analysis with IPW-weighting and interaction terms for IVT was performed to predict functional independence (mRS 0-2 at 90-days).RESULTS: 720 patients were included, of which 366 (51%) received IVT. In IPW, the treatment effect of IVT on outcome (mRS 0-2) distinctively varied according to the ASPECTS subgroup (ASPECTS 9-10: +15%, ASPECTS 6-8: +7%, ASPECTS <6: -11%). In multivariable logistic regression analysis, IVT was independently associated with functional independence (aOR: 1.57, 95% CI: 1.16-2.14, p = 0.003) and the interaction term was significant for ASPECTS and IVT revealing that IVT was only significantly associated with better outcomes in patients with higher ASPECTS. No other significant baseline variable interaction terms were identified.INTERPRETATION: ASPECTS was the only baseline variable that showed a significant interaction with IVT for outcome prediction. Use of IVT prior to MT in patients with an ASPECTS of <6 was not associated with a treatment benefit and should be considered carefully.",
author = "Gabriel Broocks and Heit, {Jeremy J} and Kuraitis, {Gabriella M} and Lukas Meyer and {van Horn}, Noel and Matthias Bechstein and Christian Thaler and Soren Christensen and Michael Mlynash and Lansberg, {Maarten G} and Andre Kemmling and Gerhard Sch{\"o}n and Gregory Albers and Jens Fiehler and Max Wintermark and Faizy, {Tobias D}",
note = "This article is protected by copyright. All rights reserved.",
year = "2022",
month = oct,
doi = "10.1002/ana.26451",
language = "English",
volume = "92",
pages = "588--595",
journal = "ANN NEUROL",
issn = "0364-5134",
publisher = "John Wiley and Sons Inc.",
number = "4",

}

RIS

TY - JOUR

T1 - Benefit of Intravenous Alteplase Before Thrombectomy Depends on ASPECTS

AU - Broocks, Gabriel

AU - Heit, Jeremy J

AU - Kuraitis, Gabriella M

AU - Meyer, Lukas

AU - van Horn, Noel

AU - Bechstein, Matthias

AU - Thaler, Christian

AU - Christensen, Soren

AU - Mlynash, Michael

AU - Lansberg, Maarten G

AU - Kemmling, Andre

AU - Schön, Gerhard

AU - Albers, Gregory

AU - Fiehler, Jens

AU - Wintermark, Max

AU - Faizy, Tobias D

N1 - This article is protected by copyright. All rights reserved.

PY - 2022/10

Y1 - 2022/10

N2 - PURPOSE: Baseline variables could be used to guide the administration of additional intravenous alteplase (IVT) before mechanical thrombectomy (MT). The aim of this study was to determine how baseline imaging and demographic parameters modify the effect of IVT on clinical outcomes in patients with ischemic stroke due to large vessel occlusion.METHODS: Multicenter retrospective cohort study of ischemic stroke patients triaged by multimodal-CT undergoing MT treatment after direct admission to an MT-eligible center. Inverse-probability weighting analysis (IPW) was used to assess the treatment effect of IVT adjusted for baseline variables. Multivariable logistic regression analysis with IPW-weighting and interaction terms for IVT was performed to predict functional independence (mRS 0-2 at 90-days).RESULTS: 720 patients were included, of which 366 (51%) received IVT. In IPW, the treatment effect of IVT on outcome (mRS 0-2) distinctively varied according to the ASPECTS subgroup (ASPECTS 9-10: +15%, ASPECTS 6-8: +7%, ASPECTS <6: -11%). In multivariable logistic regression analysis, IVT was independently associated with functional independence (aOR: 1.57, 95% CI: 1.16-2.14, p = 0.003) and the interaction term was significant for ASPECTS and IVT revealing that IVT was only significantly associated with better outcomes in patients with higher ASPECTS. No other significant baseline variable interaction terms were identified.INTERPRETATION: ASPECTS was the only baseline variable that showed a significant interaction with IVT for outcome prediction. Use of IVT prior to MT in patients with an ASPECTS of <6 was not associated with a treatment benefit and should be considered carefully.

AB - PURPOSE: Baseline variables could be used to guide the administration of additional intravenous alteplase (IVT) before mechanical thrombectomy (MT). The aim of this study was to determine how baseline imaging and demographic parameters modify the effect of IVT on clinical outcomes in patients with ischemic stroke due to large vessel occlusion.METHODS: Multicenter retrospective cohort study of ischemic stroke patients triaged by multimodal-CT undergoing MT treatment after direct admission to an MT-eligible center. Inverse-probability weighting analysis (IPW) was used to assess the treatment effect of IVT adjusted for baseline variables. Multivariable logistic regression analysis with IPW-weighting and interaction terms for IVT was performed to predict functional independence (mRS 0-2 at 90-days).RESULTS: 720 patients were included, of which 366 (51%) received IVT. In IPW, the treatment effect of IVT on outcome (mRS 0-2) distinctively varied according to the ASPECTS subgroup (ASPECTS 9-10: +15%, ASPECTS 6-8: +7%, ASPECTS <6: -11%). In multivariable logistic regression analysis, IVT was independently associated with functional independence (aOR: 1.57, 95% CI: 1.16-2.14, p = 0.003) and the interaction term was significant for ASPECTS and IVT revealing that IVT was only significantly associated with better outcomes in patients with higher ASPECTS. No other significant baseline variable interaction terms were identified.INTERPRETATION: ASPECTS was the only baseline variable that showed a significant interaction with IVT for outcome prediction. Use of IVT prior to MT in patients with an ASPECTS of <6 was not associated with a treatment benefit and should be considered carefully.

U2 - 10.1002/ana.26451

DO - 10.1002/ana.26451

M3 - SCORING: Journal article

C2 - 35801346

VL - 92

SP - 588

EP - 595

JO - ANN NEUROL

JF - ANN NEUROL

SN - 0364-5134

IS - 4

ER -