Outcomes of Bridging Intravenous Thrombolysis Versus Endovascular Therapy Alone in Late-Window Acute Ischemic Stroke-Reference-Cited by-同舟云学术

Outcomes of Bridging Intravenous Thrombolysis Versus Endovascular Therapy Alone in Late-Window Acute Ischemic Stroke

Published:2024-07 Issue:7 Volume:55 Page:1767-1775
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Demeestere Jelle¹²^ORCID,Qureshi Muhammad M.³⁴⁵^ORCID,Vandewalle Lieselotte¹²^ORCID,Wouters Anke¹²^ORCID,Strbian Daniel⁶⁷^ORCID,Nogueira Raul G.⁸⁹^ORCID,Nagel Simon¹⁰¹¹^ORCID,Yamagami Hiroshi¹²^ORCID,Puetz Volker¹³¹⁴^ORCID,Abdalkader Mohamad³⁵,Haussen Diogo C.⁹^ORCID,Mohammaden Mahmoud H.⁹^ORCID,Möhlenbruch Markus A.¹⁵,Olivé-Gadea Marta¹⁶^ORCID,Winzer Simon¹³¹⁴^ORCID,Ribo Marc¹⁶^ORCID,Michel Patrik¹⁷^ORCID,Marto João Pedro¹⁸^ORCID,Tanaka Kanta¹⁹^ORCID,Yoshimura Shinichi²⁰^ORCID,Martinez-Majander Nicolas⁶⁷^ORCID,Caparros Francois²¹²²^ORCID,Henon Hilde²¹²²^ORCID,Tomppo Liisa⁶⁷^ORCID,Dusart Anne²³,Bellante Flavio²³,Ramos João Nuno²⁴^ORCID,Jesser Jessica¹⁵^ORCID,Sheth Sunil A.²⁵^ORCID,Ortega-Gutiérrez Santiago²⁶^ORCID,Siegler James E.²⁷^ORCID,Nannoni Stefania²⁸^ORCID,Kaesmacher Johannes²⁹^ORCID,Dobrocky Tomas²⁹^ORCID,Salazar-Marioni Sergio²⁵^ORCID,Farooqui Mudassir²⁶^ORCID,Virtanen Pekka³⁰⁷^ORCID,Ventura Rita¹⁸^ORCID,Zaidi Syed F.³¹^ORCID,Castonguay Alicia C.³¹^ORCID,Uchida Kazutaka²⁰^ORCID,Puri Ajit S.³²,Sakai Nobuyuki³³^ORCID,Toyoda Kazunori¹⁹^ORCID,Farzin Behzad³⁴^ORCID,Masoud Hesham E.³⁵^ORCID,Klein Piers³⁵^ORCID,Bui Jenny³,Rizzo Federica¹⁶^ORCID,Kaiser Daniel P.O.¹⁴³⁶^ORCID,Desfontaines Philippe³⁷,Strambo Davide¹⁷^ORCID,Cordonnier Charlotte²¹²²^ORCID,Lin Eugene³⁸^ORCID,Ringleb Peter A.¹¹^ORCID,Roy Daniel³⁴^ORCID,Zaidat Osama O.³⁸^ORCID,Fischer Urs³⁹^ORCID,Raymond Jean³⁴^ORCID,Lemmens Robin¹²^ORCID,Nguyen Thanh N.³⁵^ORCID

Affiliation:

1. Laboratory for Neurobiology, KU Leuven, Belgium (J.D., L.V., A.W., R.L.).

2. Neurology, UZ Leuven, Belgium (J.D., L.V., A.W., R.L.).

3. Radiology (M.M.Q., M.A., P.K., J.B., T.N.N.), Boston Medical Center, MA.

4. Radiation Oncology (M.M.Q.), Boston Medical Center, MA.

5. Boston University Chobanian & Avedisian School of Medicine, MA (M.M.Q., M.A., P.K., T.N.N.).

6. Neurology (D.S., N.M.-M., L.T.), Helsinki University Hospital, Finland.

7. University of Helsinki, Finland (D.S., N.M.-M., L.T., P.V.).

8. Neurology, Neurosurgery, University of Pittsburgh Medical Center, MA (R.G.N.).

9. Neurology, Grady Memorial Hospital, Atlanta, GA (R.G.N., D.C.H., M.H.M.).

10. Neurology, Klinikum Ludwigshafen, Germany (S.N.).

11. Neurology (S.N., P.A.R.), Heidelberg University Hospital, Germany.

12. Stroke Neurology, NHO Osaka National Hospital, Japan (H.Y.).

13. Neurology (V.P., S.W.), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.

14. Dresden Neurovascular Center (V.P., S.W., D.P.O.K.), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.

15. Neuroradiology (M.A.M., J.J.), Heidelberg University Hospital, Germany.

16. Neurology, Hospital Vall d’Hebron, Barcelona, Spain (M.O.G., M.R., F.R.).

17. Neurology, Lausanne University Hospital and University of Lausanne, Switzerland (P.M., D.S.).

18. Neurology (J.P.M., R.V.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Occidental, Lisbon, Portugal.

19. Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K. Tanaka, K. Toyoda).

20. Neurosurgery, Hyogo Medical University, Nishinomiya, Japan (S.Y., K.U.).

21. Neurology, Centre Hospitalier Universitaire de Lille, France (F.C., H.H., C.C.).

22. Neurology, University of Lille, France (F.C., H.H., C.C.).

23. Neurology, Hôpital Civil Marie Curie, Charleroi, Belgium (A.D., F.B.).

24. Radiology (J.N.R.), Hospital de Egas Moniz, Centro Hospitalar Lisboa Occidental, Lisbon, Portugal.

25. Neurology, UTHealth McGovern Medical School, Houston, TX (S.A.S., S.S.-M.).

26. Neurology, University of Iowa, Iowa City (S.O.G., M.F.).

27. Neurology, University of Chicago, IL (J.E.S.).

28. Clinical Neurosciences, University of Cambridge, United Kingdom (S.N.).

29. Diagnostic and Interventional Neuroradiology, University Hospital Bern, Switzerland (J.K., T.D.).

30. Radiology (P.V.), Helsinki University Hospital, Finland.

31. Neurology, University of Toledo, OH (S.F.Z., A.C.C.).

32. Interventional Neuroradiology, University of Massachusetts Memorial Medical Center, Worcester (A.S.P.).

33. Neurovascular Research, Kobe City Medical Center General Hospital, Japan (N.S.).

34. Interventional Neuroradiology, Centre Hospitalier de l’Universite de Montreal, Canada (B.F., D.R., J.R.).

35. Neurology, State University of New York, Syracuse (H.E.M.).

36. Institute of Neuroradiology (D.P.O.K.), Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.

37. Neurology, CHC Liège, Belgium (P.D.).

38. Neuroscience and Stroke Program, Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH (E.L., O.O.Z.).

39. Neurology, University Hospital Basel, Switzerland (U.F.).

Abstract

BACKGROUND: Studies comparing bridging intravenous thrombolysis (IVT) with direct endovascular therapy (EVT) in patients with acute ischemic stroke who present late are limited. We aimed to compare the clinical outcomes and safety of bridging IVT in patients with acute ischemic stroke due to anterior circulation large vessel occlusion who underwent EVT 6 to 24 hours after time last known well. METHODS: We enrolled patients with anterior circulation large vessel occlusion stroke and a National Institutes of Health Stroke Scale score of ≥6 from 20 centers across 10 countries in the multicenter retrospective CLEAR study (CT for Late Endovascular Reperfusion) between January 2014 and May 2022. We used inverse probability of treatment weighting modeling adjusted for clinical and imaging confounders to compare functional outcomes, reperfusion success, symptomatic intracranial hemorrhage, and mortality between EVT patients with and without prior IVT. RESULTS: Of 5098 patients screened for eligibility, we included 2749 patients, of whom 549 received bridging IVT before EVT. The timing of IVT was not recorded. Witnessed stroke onset and transfer rates were higher in the bridging IVT group (25% versus 12% and 77% versus 55%, respectively, P value for both <0.0001), and time intervals between stroke onset and treatment were shorter (time last known well—start of EVT median 560 minutes [interquartile range, 432–791] versus 724 minutes [interquartile range, 544–912]; P <0.0001). After adjustment for confounders, there was no difference in functional outcome at 3 months (adjusted common odds ratio for modified Rankin Scale shift, 1.03 [95% CI, 0.89–1.19]; P =0.72) or successful reperfusion (adjusted odds ratio, 1.19 [95% CI, 0.81–1.75]; P =0.39). There were no safety concerns associated with bridging IVT versus direct EVT (symptomatic intracranial hemorrhage: adjusted odds ratio, 0.75 [95% CI, 0.38–1.48]; P =0.40; mortality: adjusted odds ratio, 1.14 [95% CI, 0.89–1.46]; P =0.31). Results were unchanged when the analysis was limited to patients who received IVT >6 hours after last known well. CONCLUSIONS: In patients with an anterior circulation large vessel occlusion stroke who underwent EVT 6 to 24 hours from last known well, bridging IVT was not associated with a difference in outcomes compared with direct EVT. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04096248.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference28 articles.

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