Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs
Without IV Thrombolysis

J 2021

Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without IV Thrombolysis

AHMED, N., M. MAZYA, A. P. NUNES, T. MOREIRA, J. P. OLLIKAINEN et. al.

Basic information

Original name

Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without IV Thrombolysis

Authors

AHMED, N. (guarantor), M. MAZYA, A. P. NUNES, T. MOREIRA, J. P. OLLIKAINEN, I. ESCUDERO-MARTINEZ, G. BIGLIARDI, L. DORADO, A. DAVALOS, J. A. EGIDO, R. TASSI, D. STRBIAN, A. ZINI, P. NICHELLI, R. HERZIG, L. JURAK, E. HURTIKOVA, G. TSIVGOULIS, A. PEETERS, M. NEVSIMALOVA, M. BROZMAN, R. CAVALLO, K. R. LEES, Robert MIKULÍK (203 Czech Republic, belonging to the institution), D. TONI and S. HOLMIN

Edition

Neurology, Philadelphia, LIPPINCOTT WILLIAMS & WILKINS, 2021, 0028-3878

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30210 Clinical neurology

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 11.800

RIV identification code

RIV/00216224:14110/21:00122756

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1212/WNL.0000000000012327

UT WoS

000702392900015

Keywords in English

Thrombectomy; Ischemic Stroke; IV Thrombolysis

Abstract

V originále

Objective To test the hypothesis that IV thrombolysis (IVT) treatment before endovascular thrombectomy (EVT) is associated with better outcomes in patients with anterior circulation large artery occlusion (LAO) stroke, we examined a large real-world database, the Safe Implementation of Treatment in Stroke-International Stroke Thrombectomy Register (SITS-ISTR). Methods We identified centers recording >= 10 consecutive patients in the SITS-ISTR, with at least 70% available modified Rankin Scale (mRS) scores at 3 months during 2014 to 2019. We defined LAO as intracranial internal carotid artery, first and second segment of middle cerebral artery, and first segment of anterior cerebral artery. Main outcomes were functional independence (mRS score 0-2) and death at 3 months and symptomatic intracranial hemorrhage (SICH) per modified SITS-Monitoring Study. We performed propensity score-matched (PSM) and multivariable logistic regression analyses. Results Of 6,350 patients from 42 centers, 3,944 (62.1%) received IVT. IVT + EVT-treated patients had less frequent atrial fibrillation, ongoing anticoagulation, previous stroke, heart failure, and prestroke disability. PSM analysis showed that IVT + EVT-treated patients had a higher rate of functional independence than patients treated with EVT alone (46.4% vs 40.3%, p < 0.001) and a lower rate of death at 3 months (20.3% vs 23.3%, p = 0.035). SICH rates (3.5% vs 3.0%, p = 0.42) were similar in both groups. Multivariate adjustment yielded results consistent with PSM. Conclusion Pretreatment with IVT was associated with favorable outcomes in EVT-treated LAO stroke in the SITS-ISTR. These findings, while indicative of international routine clinical practice, are limited by observational design, unmeasured confounding, and possible residual confounding by indication. Classification of Evidence This study provides Class II evidence that IVT before EVT increases the probability of functional independence at 3 months compared to EVT alone.

Citovat

AHMED, N., M. MAZYA, A. P. NUNES, T. MOREIRA, J. P. OLLIKAINEN, I. ESCUDERO-MARTINEZ, G. BIGLIARDI, L. DORADO, A. DAVALOS, J. A. EGIDO, R. TASSI, D. STRBIAN, A. ZINI, P. NICHELLI, R. HERZIG, L. JURAK, E. HURTIKOVA, G. TSIVGOULIS, A. PEETERS, M. NEVSIMALOVA, M. BROZMAN, R. CAVALLO, K. R. LEES, Robert MIKULÍK, D. TONI and S. HOLMIN. Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without IV Thrombolysis. Neurology. Philadelphia: LIPPINCOTT WILLIAMS & WILKINS, 2021, vol. 97, No 8, p. "E765"-"E776", 12 pp. ISSN 0028-3878. Available from: https://dx.doi.org/10.1212/WNL.0000000000012327.

@article{1801351,
   author = {Ahmed, N. and Mazya, M. and Nunes, A. P. and Moreira, T. and Ollikainen, J. P. and EscuderoandMartinez, I. and Bigliardi, G. and Dorado, L. and Davalos, A. and Egido, J. A. and Tassi, R. and Strbian, D. and Zini, A. and Nichelli, P. and Herzig, R. and Jurak, L. and Hurtikova, E. and Tsivgoulis, G. and Peeters, A. and Nevsimalova, M. and Brozman, M. and Cavallo, R. and Lees, K. R. and Mikulík, Robert and Toni, D. and Holmin, S.},
   article_location = {Philadelphia},
   article_number = {8},
   doi = {http://dx.doi.org/10.1212/WNL.0000000000012327},
   keywords = {Thrombectomy; Ischemic Stroke; IV Thrombolysis},
   language = {eng},
   issn = {0028-3878},
   journal = {Neurology},
   title = {Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without IV Thrombolysis},
   url = {https://n.neurology.org/content/97/8/e765},
   volume = {97},
   year = {2021}
}

TY  - JOUR
ID  - 1801351
AU  - Ahmed, N. - Mazya, M. - Nunes, A. P. - Moreira, T. - Ollikainen, J. P. - Escudero-Martinez, I. - Bigliardi, G. - Dorado, L. - Davalos, A. - Egido, J. A. - Tassi, R. - Strbian, D. - Zini, A. - Nichelli, P. - Herzig, R. - Jurak, L. - Hurtikova, E. - Tsivgoulis, G. - Peeters, A. - Nevsimalova, M. - Brozman, M. - Cavallo, R. - Lees, K. R. - Mikulík, Robert - Toni, D. - Holmin, S.
PY  - 2021
TI  - Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without IV Thrombolysis
JF  - Neurology
VL  - 97
IS  - 8
SP  - "E765"-"E776"
EP  - "E765"-"E776"
PB  - LIPPINCOTT WILLIAMS & WILKINS
SN  - 00283878
KW  - Thrombectomy
KW  - Ischemic Stroke
KW  - IV Thrombolysis
UR  - https://n.neurology.org/content/97/8/e765
N2  - Objective To test the hypothesis that IV thrombolysis (IVT) treatment before endovascular thrombectomy (EVT) is associated with better outcomes in patients with anterior circulation large artery occlusion (LAO) stroke, we examined a large real-world database, the Safe Implementation of Treatment in Stroke-International Stroke Thrombectomy Register (SITS-ISTR). Methods We identified centers recording >= 10 consecutive patients in the SITS-ISTR, with at least 70% available modified Rankin Scale (mRS) scores at 3 months during 2014 to 2019. We defined LAO as intracranial internal carotid artery, first and second segment of middle cerebral artery, and first segment of anterior cerebral artery. Main outcomes were functional independence (mRS score 0-2) and death at 3 months and symptomatic intracranial hemorrhage (SICH) per modified SITS-Monitoring Study. We performed propensity score-matched (PSM) and multivariable logistic regression analyses. Results Of 6,350 patients from 42 centers, 3,944 (62.1%) received IVT. IVT + EVT-treated patients had less frequent atrial fibrillation, ongoing anticoagulation, previous stroke, heart failure, and prestroke disability. PSM analysis showed that IVT + EVT-treated patients had a higher rate of functional independence than patients treated with EVT alone (46.4% vs 40.3%, p < 0.001) and a lower rate of death at 3 months (20.3% vs 23.3%, p = 0.035). SICH rates (3.5% vs 3.0%, p = 0.42) were similar in both groups. Multivariate adjustment yielded results consistent with PSM. Conclusion Pretreatment with IVT was associated with favorable outcomes in EVT-treated LAO stroke in the SITS-ISTR. These findings, while indicative of international routine clinical practice, are limited by observational design, unmeasured confounding, and possible residual confounding by indication. Classification of Evidence This study provides Class II evidence that IVT before EVT increases the probability of functional independence at 3 months compared to EVT alone.
ER  -

AHMED, N., M. MAZYA, A. P. NUNES, T. MOREIRA, J. P. OLLIKAINEN, I. ESCUDERO-MARTINEZ, G. BIGLIARDI, L. DORADO, A. DAVALOS, J. A. EGIDO, R. TASSI, D. STRBIAN, A. ZINI, P. NICHELLI, R. HERZIG, L. JURAK, E. HURTIKOVA, G. TSIVGOULIS, A. PEETERS, M. NEVSIMALOVA, M. BROZMAN, R. CAVALLO, K. R. LEES, Robert MIKULÍK, D. TONI and S. HOLMIN. Safety and Outcomes of Thrombectomy in Ischemic Stroke With vs Without IV Thrombolysis. \textit{Neurology}. Philadelphia: LIPPINCOTT WILLIAMS \&{} WILKINS, 2021, vol.~97, No~8, p.~''E765''-''E776'', 12 pp. ISSN~0028-3878. Available from: https://dx.doi.org/10.1212/WNL.0000000000012327.

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