Intravenous Thrombolysis Is Not Associated with Increased Time to Endovascular Treatment
© 2020 The Author(s) Published by S. Karger AG, Basel..
BACKGROUND: Endovascular treatment (EVT) with or without intravenous thrombolysis (IVT) is effective and safe in is-chemic stroke caused by large vessel occlusion, but IVT might delay time to EVT or increase risk of intracranial hemorrhage (ICH). We assessed the influence of prior IVT on time to treatment and risk of ICH in patients treated with EVT.
METHODS: We analyzed data from the MR CLEAN Registry and included patients with an anterior circulation occlusion treated with EVT who presented directly to an intervention center, between 2014 and 2017. Primary endpoint was the door to groin time. Secondary outcomes were workflow time intervals and safety outcomes. We compared patients who received EVT only with patients who received IVT prior to EVT.
RESULTS: We included 1,427 patients directly referred to an intervention center of whom 1,023 (72%) received IVT + EVT. Adjusted door to CT imaging and door to groin time were shorter in IVT + EVT patients (difference 5.7 min [95% CI: 4.6-6.8] and 7.0 min [95% CI: 2.4-12], respectively) while CT imaging to groin time was similar between the groups. Early recanalization on digital subtraction angiography before EVT was seen more often after prior IVT (11 vs. 5.2%, aOR 2.4 [95% CI: 1.4-4.2]). Rates of symptomatic ICH were similar.
CONCLUSION: Prior IVT did not delay door to groin times and was associated with higher rates of early recanalization, without increasing the risk of ICH. Our results do not warrant withholding IVT prior to EVT.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2020 |
|---|---|
| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:49 |
|---|---|
| Enthalten in: |
Cerebrovascular diseases (Basel, Switzerland) - 49(2020), 3 vom: 20., Seite 321-327 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Hinsenveld, Wouter H [VerfasserIn] |
|---|
| Links: |
|---|
| Anmerkungen: |
Date Completed 30.11.2020 Date Revised 30.11.2020 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1159/000508898 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM311933629 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM311933629 | ||
| 003 | DE-627 | ||
| 005 | 20231225143323.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231225s2020 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1159/000508898 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1039.xml |
| 035 | |a (DE-627)NLM311933629 | ||
| 035 | |a (NLM)32615562 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Hinsenveld, Wouter H |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Intravenous Thrombolysis Is Not Associated with Increased Time to Endovascular Treatment |
| 264 | 1 | |c 2020 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 30.11.2020 | ||
| 500 | |a Date Revised 30.11.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 The Author(s) Published by S. Karger AG, Basel. | ||
| 520 | |a BACKGROUND: Endovascular treatment (EVT) with or without intravenous thrombolysis (IVT) is effective and safe in is-chemic stroke caused by large vessel occlusion, but IVT might delay time to EVT or increase risk of intracranial hemorrhage (ICH). We assessed the influence of prior IVT on time to treatment and risk of ICH in patients treated with EVT | ||
| 520 | |a METHODS: We analyzed data from the MR CLEAN Registry and included patients with an anterior circulation occlusion treated with EVT who presented directly to an intervention center, between 2014 and 2017. Primary endpoint was the door to groin time. Secondary outcomes were workflow time intervals and safety outcomes. We compared patients who received EVT only with patients who received IVT prior to EVT | ||
| 520 | |a RESULTS: We included 1,427 patients directly referred to an intervention center of whom 1,023 (72%) received IVT + EVT. Adjusted door to CT imaging and door to groin time were shorter in IVT + EVT patients (difference 5.7 min [95% CI: 4.6-6.8] and 7.0 min [95% CI: 2.4-12], respectively) while CT imaging to groin time was similar between the groups. Early recanalization on digital subtraction angiography before EVT was seen more often after prior IVT (11 vs. 5.2%, aOR 2.4 [95% CI: 1.4-4.2]). Rates of symptomatic ICH were similar | ||
| 520 | |a CONCLUSION: Prior IVT did not delay door to groin times and was associated with higher rates of early recanalization, without increasing the risk of ICH. Our results do not warrant withholding IVT prior to EVT | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Acute stroke intervention | |
| 650 | 4 | |a Endovascular treatment of acute stroke | |
| 650 | 4 | |a Intravenous thrombolytic therapy of stroke | |
| 650 | 4 | |a Stroke organization | |
| 650 | 4 | |a Workflow | |
| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 700 | 1 | |a de Ridder, Inger R |e verfasserin |4 aut | |
| 700 | 1 | |a van Oostenbrugge, Robert J |e verfasserin |4 aut | |
| 700 | 1 | |a van Zwam, Wim H |e verfasserin |4 aut | |
| 700 | 1 | |a Vos, Jan Albert |e verfasserin |4 aut | |
| 700 | 1 | |a Coutinho, Jonathan M |e verfasserin |4 aut | |
| 700 | 1 | |a Lycklama À Nijeholt, Geert J |e verfasserin |4 aut | |
| 700 | 1 | |a Boiten, Jelis |e verfasserin |4 aut | |
| 700 | 1 | |a Schonewille, Wouter J |e verfasserin |4 aut | |
| 700 | 0 | |a MR CLEAN Registry Investigators |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Cerebrovascular diseases (Basel, Switzerland) |d 1997 |g 49(2020), 3 vom: 20., Seite 321-327 |w (DE-627)NLM090577663 |x 1421-9786 |7 nnns |
| 773 | 1 | 8 | |g volume:49 |g year:2020 |g number:3 |g day:20 |g pages:321-327 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1159/000508898 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 49 |j 2020 |e 3 |b 20 |h 321-327 | ||