Intravenous Thrombolysis Before Endovascular Treatment in Posterior Circulation Occlusions : A MR CLEAN Registry Study
BACKGROUND: The effectiveness of intravenous thrombolysis (IVT) before endovascular treatment (EVT) has been investigated in randomized trials and meta-analyses. These studies mainly concerned anterior circulation occlusions. We aimed to investigate clinical, technical, and safety outcomes of IVT before EVT in posterior circulation occlusions in a nationwide registry.
METHODS: Patients were included from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), a nationwide, prospective, multicenter registry of patients with acute ischemic stroke due to a large intracranial vessel occlusion receiving EVT between 2014 and 2019. All patients with a posterior circulation occlusion were included. Primary outcome was a shift toward better functional outcome on the modified Rankin Scale at 90 days. Secondary outcomes were favorable functional outcome (modified Rankin Scale scores, 0-3), occurrence of symptomatic intracranial hemorrhages, successful reperfusion (extended Thrombolysis in Cerebral Ischemia ≥2B), first-attempt successful reperfusion, and mortality at 90 days. Regression analyses with adjustments based on univariable analyses and literature were applied.
RESULTS: A total of 248 patients were included, who received either IVT (n=125) or no IVT (n=123) before EVT. Results show no differences in a shift on the modified Rankin Scale (adjusted common odds ratio, 1.04 [95% CI, 0.61-1.76]). Although symptomatic intracranial hemorrhages occurred more often in the IVT group (4.8% versus 2.4%), regression analysis did not show a significant difference (adjusted odds ratio, 1.65 [95% CI, 0.33-8.35]). Successful reperfusion, favorable functional outcome, first-attempt successful reperfusion, and mortality did not differ between patients treated with and without IVT.
CONCLUSIONS: We found no significant differences in clinical, technical, and safety outcomes between patients with a large vessel occlusion in the posterior circulation treated with or without IVT before EVT. Our results are in line with the literature on the anterior circulation.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:55 |
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| Enthalten in: |
Stroke - 55(2024), 2 vom: 04. Feb., Seite 403-412 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Knapen, Robrecht R M M [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 01.02.2024 Date Revised 01.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1161/STROKEAHA.123.043777 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM366651978 |
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| 100 | 1 | |a Knapen, Robrecht R M M |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Intravenous Thrombolysis Before Endovascular Treatment in Posterior Circulation Occlusions |b A MR CLEAN Registry Study |
| 264 | 1 | |c 2024 | |
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| 500 | |a Date Revised 01.02.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a BACKGROUND: The effectiveness of intravenous thrombolysis (IVT) before endovascular treatment (EVT) has been investigated in randomized trials and meta-analyses. These studies mainly concerned anterior circulation occlusions. We aimed to investigate clinical, technical, and safety outcomes of IVT before EVT in posterior circulation occlusions in a nationwide registry | ||
| 520 | |a METHODS: Patients were included from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), a nationwide, prospective, multicenter registry of patients with acute ischemic stroke due to a large intracranial vessel occlusion receiving EVT between 2014 and 2019. All patients with a posterior circulation occlusion were included. Primary outcome was a shift toward better functional outcome on the modified Rankin Scale at 90 days. Secondary outcomes were favorable functional outcome (modified Rankin Scale scores, 0-3), occurrence of symptomatic intracranial hemorrhages, successful reperfusion (extended Thrombolysis in Cerebral Ischemia ≥2B), first-attempt successful reperfusion, and mortality at 90 days. Regression analyses with adjustments based on univariable analyses and literature were applied | ||
| 520 | |a RESULTS: A total of 248 patients were included, who received either IVT (n=125) or no IVT (n=123) before EVT. Results show no differences in a shift on the modified Rankin Scale (adjusted common odds ratio, 1.04 [95% CI, 0.61-1.76]). Although symptomatic intracranial hemorrhages occurred more often in the IVT group (4.8% versus 2.4%), regression analysis did not show a significant difference (adjusted odds ratio, 1.65 [95% CI, 0.33-8.35]). Successful reperfusion, favorable functional outcome, first-attempt successful reperfusion, and mortality did not differ between patients treated with and without IVT | ||
| 520 | |a CONCLUSIONS: We found no significant differences in clinical, technical, and safety outcomes between patients with a large vessel occlusion in the posterior circulation treated with or without IVT before EVT. Our results are in line with the literature on the anterior circulation | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a posterior circulation | |
| 650 | 4 | |a stroke | |
| 650 | 4 | |a thrombectomy | |
| 650 | 4 | |a thrombolytic therapy | |
| 700 | 1 | |a Pirson, F Anne V |e verfasserin |4 aut | |
| 700 | 1 | |a Langezaal, Lucianne C M |e verfasserin |4 aut | |
| 700 | 1 | |a Brouwer, Josje |e verfasserin |4 aut | |
| 700 | 1 | |a Majoie, Charles B L M |e verfasserin |4 aut | |
| 700 | 1 | |a Emmer, Bart J |e verfasserin |4 aut | |
| 700 | 1 | |a Vos, Jan-Albert |e verfasserin |4 aut | |
| 700 | 1 | |a van Doormaal, Pieter-Jan |e verfasserin |4 aut | |
| 700 | 1 | |a Yoo, Albert J |e verfasserin |4 aut | |
| 700 | 1 | |a Bruggeman, Agnetha A E |e verfasserin |4 aut | |
| 700 | 1 | |a Lycklama À Nijeholt, Geert J |e verfasserin |4 aut | |
| 700 | 1 | |a van der Leij, Chirstiaan |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 Schonewille, Wouter J |e verfasserin |4 aut | |
| 700 | 0 | |a MR CLEAN Registry Investigators |e verfasserin |4 aut | |
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| 700 | 1 | |a van der Lugt, Aad |e investigator |4 oth | |
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| 700 | 1 | |a Boiten, Jelis |e investigator |4 oth | |
| 700 | 1 | |a Jansen, Ivo G H |e investigator |4 oth | |
| 700 | 1 | |a Mulder, Maxim J H L |e investigator |4 oth | |
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| 700 | 1 | |a Roozenbeek, Bob |e investigator |4 oth | |
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| 700 | 1 | |a Wermer, Marieke J H |e investigator |4 oth | |
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