Intravenous Thrombolysis 4.5–9 Hours After Stroke Onset: A Cohort Study from the <scp>TRISP</scp> Collaboration-Reference-Cited by-同舟云学术

Intravenous Thrombolysis 4.5–9 Hours After Stroke Onset: A Cohort Study from the TRISP Collaboration

Published:2023-05-13 Issue:2 Volume:94 Page:309-320
ISSN:0364-5134
Container-title:Annals of Neurology
language:en
Short-container-title:Annals of Neurology

Author:

Altersberger Valerian L.¹^ORCID,Sibolt Gerli²,Enz Lukas S.¹,Hametner Christian³,Scheitz Jan F.⁴,Henon Hilde⁵,Bigliardi Guido⁶,Strambo Davide⁷,Martinez‐Majander Nicolas²,Stolze Lotte J.⁸,Heldner Mirjam R.⁹^ORCID,Grisendi Ilaria¹⁰,Jovanovic Dejana R.¹¹,Bejot Yannick¹²,Pezzini Alessandro¹³¹⁴^ORCID,Leker Ronen R.¹⁵,Kägi Georg¹⁶,Wegener Susanne¹⁷^ORCID,Cereda Carlo W.¹⁸^ORCID,Ntaios Georges¹⁹,De Marchis Gian Marco¹^ORCID,Bonati Leo H.¹,Psychogios Marios²⁰,Lyrer Philippe¹,Räty Silja²^ORCID,Tiainen Marjaana²,Wouters Anke⁸,Caparros François⁵,Heyse Miriam³,Erdur Hebun⁴^ORCID,Padjen Visnja¹¹,Zedde Marialuisa¹⁰,Arnold Marcel⁹,Nederkoorn Paul J.⁸,Michel Patrik⁷,Zini Andrea²¹,Cordonnier Charlotte⁵^ORCID,Nolte Christian H.⁴,Ringleb Peter A.³,Curtze Sami²^ORCID,Engelter Stefan T.¹²²,Gensicke Henrik¹²²^ORCID,

Affiliation:

1. Stroke Center and Department of Neurology University Hospital Basel and University of Basel Basel Switzerland

2. Department of Neurology University of Helsinki and Helsinki University Hospital Helsinki Finland

3. Department of Neurology University Hospital Heidelberg Heidelberg Germany

4. Department of Neurology with Experimental Neurology, Charité‐Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB) Charité‐Universitätsmedizin Berlin Berlin Germany

5. Univ. Lille, Inserm, CHU Lille Lille Neuroscience & Cognition Lille France

6. Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara Modena University Hospital Modena Italy

7. Stroke Center, Neurology Service Lausanne University Hospital and University of Lausanne Lausanne Switzerland

8. Department of Neurology, Amsterdam UMC University of Amsterdam Amsterdam the Netherlands

9. Department of Neurology Inselspital, Bern University Hospital and University of Bern Bern Switzerland

10. Neurology Unit‐Stroke Unit, Azienda Unità Sanitaria Locale‐IRCCS di Reggio Emilia Reggio Emilia Italy

11. Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine University of Belgrade Belgrade Serbia

12. Department of Neurology University Hospital Dijon Dijon France

13. Neurology Clinic, Department of Clinical and Experimental Sciences University of Brescia Brescia Italy

14. Department of Neurological Sciences and Vision, ASST Spedali Civili Brescia Italy

15. Department of Neurology Hadassah‐Hebrew University Medical Center Jerusalem Israel

16. Department of Neurology, Kantonsspital St. Gallen St. Gallen Switzerland

17. Department of Neurology University Hospital Zurich and University of Zurich Zurich Switzerland

18. Stroke Center and Department of Neurology, Neurocenter of Southern Switzerland Lugano Switzerland

19. Department of Internal Medicine, Faculty of Medicine, School of Health Sciences University of Thessaly Larissa Greece

20. Department of Neuroradiology University Hospital Basel and University of Basel Basel Switzerland

21. IRCCS Istituto delle Scienze Neurologiche di Bologna Department of Neurology and Stroke Center, Maggiore Hospital Bologna Italy

22. Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER University of Basel Basel Switzerland

Abstract

ObjectiveTo investigate the safety and effectiveness of intravenous thrombolysis (IVT) >4.5–9 hours after stroke onset, and the relevance of advanced neuroimaging for patient selection.MethodsProspective multicenter cohort study from the ThRombolysis in Ischemic Stroke Patients (TRISP) collaboration. Outcomes were symptomatic intracranial hemorrhage, poor 3‐month functional outcome (modified Rankin scale 3–6) and mortality. We compared: (i) IVT >4.5–9 hours versus 0–4.5 hours after stroke onset and (ii) within the >4.5–9 hours group baseline advanced neuroimaging (computed tomography perfusion, magnetic resonance perfusion or magnetic resonance diffusion‐weighted imaging fluid‐attenuated inversion recovery) versus non‐advanced neuroimaging.ResultsOf 15,827 patients, 663 (4.2%) received IVT >4.5–9 hours and 15,164 (95.8%) within 4.5 hours after stroke onset. The main baseline characteristics were evenly distributed between both groups. Time of stroke onset was known in 74.9% of patients treated between >4.5 and 9 hours. Using propensity score weighted binary logistic regression analysis (onset‐to‐treatment time >4.5–9 hours vs onset‐to‐treatment time 0–4.5 hours), the probability of symptomatic intracranial hemorrhage (ORadjusted 0.80, 95% CI 0.53–1.17), poor functional outcome (ORadjusted 1.01, 95% CI 0.83–1.22), and mortality (ORadjusted 0.80, 95% CI 0.61–1.04) did not differ significantly between both groups. In patients treated between >4.5 and 9 hours, the use of advanced neuroimaging was associated with a 50% lower mortality compared with non‐advanced imaging only (9.9% vs 19.7%; ORadjusted 0.51, 95% CI 0.33–0.79).InterpretationThis study showed no evidence in difference of symptomatic intracranial hemorrhage, poor outcome, and mortality in selected stroke patients treated with IVT between >4.5 and 9 hours after stroke onset compared with those treated within 4.5 hours. Advanced neuroimaging for patient selection was associated with lower mortality. ANN NEUROL 2023;94:309–320

Publisher

Wiley

Subject

Neurology (clinical),Neurology

Link

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ana.26669

Reference20 articles.

1. Do Clinicians Overestimate the Severity of Intracerebral Hemorrhage?

2. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke

3. Extending thrombolysis to 4·5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data

4. Cohort profile: Thrombolysis in Ischemic Stroke Patients (TRISP): a multicentre research collaboration

5. IV thrombolysis and statins