Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ..
BACKGROUND: Intravenous alteplase treatment (IVT) for acute ischemic stroke carries a risk of intracranial hemorrhage (ICH). However, reperfusion of an occluded vessel itself may contribute to the risk of ICH. We determined whether IVT and reperfusion are associated with ICH or its volume in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN)-NO IV trial.
METHODS: The MR CLEAN-NO IV trial randomized patients with acute ischemic stroke due to large vessel occlusion to receive either IVT followed by endovascular treatment (EVT) or EVT alone. ICH was classified according to the Heidelberg bleeding classification on follow-up MRI or CT approximately 8 hours-7 days after stroke. Hemorrhage volume was measured with ITK-snap. Successful reperfusion was defined as extended Thrombolysis In Cerebral Infarction (eTICI) score of 2b-3. Multinomial and binary adjusted logistic regression were used to determine the association of IVT and reperfusion with ICH subtypes.
RESULTS: Of 539 included patients, 173 (32%) developed ICH and 30 suffered from symptomatic ICH (sICH) (6%). Of the patients with ICH, 102 had hemorrhagic infarction, 47 had parenchymal hematoma, 44 had SAH, and six had other ICH. Reperfusion was associated with a decreased risk of SAH, and IVT was not associated with SAH (eTICI 2b-3: adjusted OR 0.45, 95% CI 0.21 to 0.97; EVT without IVT: OR 1.6, 95% CI 0.91 to 2.8). Reperfusion status and IVT were not associated with overall ICH, hemorrhage volume, and sICH (sICH: EVT without IVT, OR 0.96, 95% CI 0.41 to 2.25; eTICI 2b-3, OR 0.49, 95% CI 0.23 to 1.05).
CONCLUSION: Neither IVT administration before EVT nor successful reperfusion after EVT were associated with ICH, hemorrhage volume, and sICH. SAH occurred more often in patients for whom successful reperfusion was not achieved.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:15 |
|---|---|
| Enthalten in: |
Journal of neurointerventional surgery - 15(2023), e2 vom: 18. Nov., Seite e262-e269 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
van Kranendonk, Katinka R [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
EC 3.4.21.68 |
|---|
| Anmerkungen: |
Date Completed 06.11.2023 Date Revised 06.11.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1136/jnis-2022-019569 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM349097208 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM349097208 | ||
| 003 | DE-627 | ||
| 005 | 20231226041818.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1136/jnis-2022-019569 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1163.xml |
| 035 | |a (DE-627)NLM349097208 | ||
| 035 | |a (NLM)36396434 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a van Kranendonk, Katinka R |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone |
| 264 | 1 | |c 2023 | |
| 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 06.11.2023 | ||
| 500 | |a Date Revised 06.11.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a BACKGROUND: Intravenous alteplase treatment (IVT) for acute ischemic stroke carries a risk of intracranial hemorrhage (ICH). However, reperfusion of an occluded vessel itself may contribute to the risk of ICH. We determined whether IVT and reperfusion are associated with ICH or its volume in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN)-NO IV trial | ||
| 520 | |a METHODS: The MR CLEAN-NO IV trial randomized patients with acute ischemic stroke due to large vessel occlusion to receive either IVT followed by endovascular treatment (EVT) or EVT alone. ICH was classified according to the Heidelberg bleeding classification on follow-up MRI or CT approximately 8 hours-7 days after stroke. Hemorrhage volume was measured with ITK-snap. Successful reperfusion was defined as extended Thrombolysis In Cerebral Infarction (eTICI) score of 2b-3. Multinomial and binary adjusted logistic regression were used to determine the association of IVT and reperfusion with ICH subtypes | ||
| 520 | |a RESULTS: Of 539 included patients, 173 (32%) developed ICH and 30 suffered from symptomatic ICH (sICH) (6%). Of the patients with ICH, 102 had hemorrhagic infarction, 47 had parenchymal hematoma, 44 had SAH, and six had other ICH. Reperfusion was associated with a decreased risk of SAH, and IVT was not associated with SAH (eTICI 2b-3: adjusted OR 0.45, 95% CI 0.21 to 0.97; EVT without IVT: OR 1.6, 95% CI 0.91 to 2.8). Reperfusion status and IVT were not associated with overall ICH, hemorrhage volume, and sICH (sICH: EVT without IVT, OR 0.96, 95% CI 0.41 to 2.25; eTICI 2b-3, OR 0.49, 95% CI 0.23 to 1.05) | ||
| 520 | |a CONCLUSION: Neither IVT administration before EVT nor successful reperfusion after EVT were associated with ICH, hemorrhage volume, and sICH. SAH occurred more often in patients for whom successful reperfusion was not achieved | ||
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Hemorrhage | |
| 650 | 4 | |a Stroke | |
| 650 | 4 | |a Thrombectomy | |
| 650 | 4 | |a Thrombolysis | |
| 650 | 7 | |a Tissue Plasminogen Activator |2 NLM | |
| 650 | 7 | |a EC 3.4.21.68 |2 NLM | |
| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 700 | 1 | |a Kappelhof, Manon |e verfasserin |4 aut | |
| 700 | 1 | |a Bruggeman, Agnetha A E |e verfasserin |4 aut | |
| 700 | 1 | |a Rinkel, Leon A |e verfasserin |4 aut | |
| 700 | 1 | |a Treurniet, Kilian M |e verfasserin |4 aut | |
| 700 | 1 | |a LeCouffe, Natalie |e verfasserin |4 aut | |
| 700 | 1 | |a Emmer, Bart J |e verfasserin |4 aut | |
| 700 | 1 | |a Coutinho, Jonathan M |e verfasserin |4 aut | |
| 700 | 1 | |a Wolff, Lennard |e verfasserin |4 aut | |
| 700 | 1 | |a van Zwam, Wim H |e verfasserin |4 aut | |
| 700 | 1 | |a van Oostenbrugge, Robert J |e verfasserin |4 aut | |
| 700 | 1 | |a van der Lugt, Aad |e verfasserin |4 aut | |
| 700 | 1 | |a Dippel, Diederik W J |e verfasserin |4 aut | |
| 700 | 1 | |a Roos, Yvo B W E M |e verfasserin |4 aut | |
| 700 | 1 | |a Marquering, Henk A |e verfasserin |4 aut | |
| 700 | 1 | |a Majoie, Charles B L M |e verfasserin |4 aut | |
| 700 | 0 | |a MR CLEAN-NO IV Investigators |e verfasserin |4 aut | |
| 700 | 1 | |a Roos, Yvo |e investigator |4 oth | |
| 700 | 1 | |a Majoie, Charles |e investigator |4 oth | |
| 700 | 1 | |a Treurniet, Kilian |e investigator |4 oth | |
| 700 | 1 | |a Coutinho, Jonathan |e investigator |4 oth | |
| 700 | 1 | |a Emmer, Bart |e investigator |4 oth | |
| 700 | 1 | |a LeCouffe, Natalie |e investigator |4 oth | |
| 700 | 1 | |a Kappelhof, Manon |e investigator |4 oth | |
| 700 | 1 | |a Rinkel, Leon |e investigator |4 oth | |
| 700 | 1 | |a Bruggeman, Agnetha |e investigator |4 oth | |
| 700 | 1 | |a Roozenbeek, Bob |e investigator |4 oth | |
| 700 | 1 | |a Es, Adriaan van |e investigator |4 oth | |
| 700 | 1 | |a Ridder, Inger de |e investigator |4 oth | |
| 700 | 1 | |a Zwam, Wim van |e investigator |4 oth | |
| 700 | 1 | |a Worp, Bart van der |e investigator |4 oth | |
| 700 | 1 | |a Lo, Rob |e investigator |4 oth | |
| 700 | 1 | |a Keizer, Koos |e investigator |4 oth | |
| 700 | 1 | |a Gons, Rob |e investigator |4 oth | |
| 700 | 1 | |a Yo, Lonneke |e investigator |4 oth | |
| 700 | 1 | |a Boiten, Jelis |e investigator |4 oth | |
| 700 | 1 | |a Wijngaard, Ido van den |e investigator |4 oth | |
| 700 | 1 | |a LycklamaNijeholt, Geert LycklamaGeert |e investigator |4 oth | |
| 700 | 1 | |a Lycklama, Geert |e investigator |4 oth | |
| 700 | 1 | |a Hofmeijer, Jeannette |e investigator |4 oth | |
| 700 | 1 | |a Martens, Jasper |e investigator |4 oth | |
| 700 | 1 | |a Schonewille, Wouter |e investigator |4 oth | |
| 700 | 1 | |a Vos, Jan Albert |e investigator |4 oth | |
| 700 | 1 | |a Tuladhar, Anil |e investigator |4 oth | |
| 700 | 1 | |a Schreuder, Floris |e investigator |4 oth | |
| 700 | 1 | |a Boogaarts, Jeroen |e investigator |4 oth | |
| 700 | 1 | |a Jenniskens, Sjoerd |e investigator |4 oth | |
| 700 | 1 | |a Laat, Karlijn de |e investigator |4 oth | |
| 700 | 1 | |a Dijk, Lukas van |e investigator |4 oth | |
| 700 | 1 | |a Hertog, Heleen den |e investigator |4 oth | |
| 700 | 1 | |a Hasselt, Boudewijn van |e investigator |4 oth | |
| 700 | 1 | |a Brouwers, Paul |e investigator |4 oth | |
| 700 | 1 | |a Sturm, Emiel |e investigator |4 oth | |
| 700 | 1 | |a Bulut, Tomas |e investigator |4 oth | |
| 700 | 1 | |a Remmers, Michel |e investigator |4 oth | |
| 700 | 1 | |a Norden, Anouk van |e investigator |4 oth | |
| 700 | 1 | |a Jong, Thijs de |e investigator |4 oth | |
| 700 | 1 | |a Rozeman, Anouk |e investigator |4 oth | |
| 700 | 1 | |a Elgersma, Otto |e investigator |4 oth | |
| 700 | 1 | |a Uyttenboogaart, Maarten |e investigator |4 oth | |
| 700 | 1 | |a Bokkers, Reinoud |e investigator |4 oth | |
| 700 | 1 | |a Tuijl, Julia van |e investigator |4 oth | |
| 700 | 1 | |a Boukrab, Issam |e investigator |4 oth | |
| 700 | 1 | |a Kortman, Hans |e investigator |4 oth | |
| 700 | 1 | |a Costalat, Vincent |e investigator |4 oth | |
| 700 | 1 | |a Arquizan, Caroline |e investigator |4 oth | |
| 700 | 1 | |a Lemmens, Robin |e investigator |4 oth | |
| 700 | 1 | |a Demeestere, Jelle |e investigator |4 oth | |
| 700 | 1 | |a Desfontaines, Philippe |e investigator |4 oth | |
| 700 | 1 | |a Brisbois, Denis |e investigator |4 oth | |
| 700 | 1 | |a Clarençon, Frédéric |e investigator |4 oth | |
| 700 | 1 | |a Samson, Yves |e investigator |4 oth | |
| 700 | 1 | |a Brown, Martin |e investigator |4 oth | |
| 700 | 1 | |a White, Phil |e investigator |4 oth | |
| 700 | 1 | |a Gregson, John |e investigator |4 oth | |
| 700 | 1 | |a Nieboer, Daan |e investigator |4 oth | |
| 700 | 1 | |a Dippel, Diederik |e investigator |4 oth | |
| 700 | 1 | |a Nuland, Rick van |e investigator |4 oth | |
| 700 | 1 | |a Lugt, Aad van der |e investigator |4 oth | |
| 700 | 1 | |a Jacobi, Linda |e investigator |4 oth | |
| 700 | 1 | |a Berg, René van den |e investigator |4 oth | |
| 700 | 1 | |a Beenen, Ludo |e investigator |4 oth | |
| 700 | 1 | |a Doormaal, Pieter-Jan van |e investigator |4 oth | |
| 700 | 1 | |a Yoo, Albert |e investigator |4 oth | |
| 700 | 1 | |a Hammer, Bas |e investigator |4 oth | |
| 700 | 1 | |a Roosendaal, Stefan |e investigator |4 oth | |
| 700 | 1 | |a Meijer, Anton |e investigator |4 oth | |
| 700 | 1 | |a Krietemeijer, Menno |e investigator |4 oth | |
| 700 | 1 | |a Hoorn, Anouk van der |e investigator |4 oth | |
| 700 | 1 | |a Gerrits, Dick |e investigator |4 oth | |
| 700 | 1 | |a Oostenbrugge, Robert van |e investigator |4 oth | |
| 700 | 1 | |a Ben Jansen, Sanne Manschot |e investigator |4 oth | |
| 700 | 1 | |a Kerkhof, Henk |e investigator |4 oth | |
| 700 | 1 | |a Koudstaal, Peter |e investigator |4 oth | |
| 700 | 1 | |a Lingsma, Hester |e investigator |4 oth | |
| 700 | 1 | |a Chalos, Vicky |e investigator |4 oth | |
| 700 | 1 | |a Berkhemer, Olvert |e investigator |4 oth | |
| 700 | 1 | |a Versteeg, Adriaan |e investigator |4 oth | |
| 700 | 1 | |a Wolff, Lennard |e investigator |4 oth | |
| 700 | 1 | |a Su, Jiahang |e investigator |4 oth | |
| 700 | 1 | |a Tolhuisen, Manon |e investigator |4 oth | |
| 700 | 1 | |a Voorst, Henk van |e investigator |4 oth | |
| 700 | 1 | |a Cate, Hugo Ten |e investigator |4 oth | |
| 700 | 1 | |a Maat, Moniek de |e investigator |4 oth | |
| 700 | 1 | |a Donse-Donkel, Samantha |e investigator |4 oth | |
| 700 | 1 | |a Beusekom, Heleen van |e investigator |4 oth | |
| 700 | 1 | |a Taha, Aladdin |e investigator |4 oth | |
| 700 | 1 | |a Berg, Sophie van den |e investigator |4 oth | |
| 700 | 1 | |a Graaf, Rob van de |e investigator |4 oth | |
| 700 | 1 | |a Goldhoorn, Robert-Jan |e investigator |4 oth | |
| 700 | 1 | |a Hinsenveld, Wouter |e investigator |4 oth | |
| 700 | 1 | |a Pirson, Anne |e investigator |4 oth | |
| 700 | 1 | |a Sondag, Lotte |e investigator |4 oth | |
| 700 | 1 | |a Reinink, Rik |e investigator |4 oth | |
| 700 | 1 | |a Brouwer, Josje |e investigator |4 oth | |
| 700 | 1 | |a Collette, Sabine |e investigator |4 oth | |
| 700 | 1 | |a Steen, Wouter van der |e investigator |4 oth | |
| 773 | 0 | 8 | |i Enthalten in |t Journal of neurointerventional surgery |d 2009 |g 15(2023), e2 vom: 18. Nov., Seite e262-e269 |w (DE-627)NLM19772521X |x 1759-8486 |7 nnns |
| 773 | 1 | 8 | |g volume:15 |g year:2023 |g number:e2 |g day:18 |g month:11 |g pages:e262-e269 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1136/jnis-2022-019569 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 15 |j 2023 |e e2 |b 18 |c 11 |h e262-e269 | ||