Effect of intravenous thrombolysis before endovascular therapy on outcome according to collateral status: insight from the ETIS Registry

Abstract

BackgroundIt is unknown whether collateral status modifies the effect of pretreatment intravenous thrombolysis (IVT) on the outcomes of patients with large vessel occlusions treated with endovascular therapy (EVT). We aimed to assess whether collateral status modifies the effect of IVT on the outcomes of EVT in clinical practice.MethodsWe used data from the ongoing prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France. Patients with anterior circulation proximal large vessel occlusions treated with EVT within 6 hours of symptom onset were enrolled. Patients were divided into two groups based on pretreatment with IVT. The two groups were matched based on baseline characteristics. We tested the interaction between collateral status and IVT in unadjusted and adjusted models.ResultsA total of 1589 patients were enrolled in the study, of whom 55% received IVT. Using a propensity score matching method, 724 no IVT patients were matched to 549 IVT patients. In propensity score weighted analysis, IVT was associated with higher odds of early neurological improvement (OR 1.74; 95% CI 1.33 to 2.26), favorable functional outcome (OR 1.66; 95% CI 1.23 to 2.24), excellent functional outcome (OR 2.04; 95% CI 1.47 to 2.83), and successful reperfusion (OR 2.18; 95% CI 1.51 to 3.16). IVT was not associated with mortality or hemorrhagic complications. There was no interaction between collateral status and IVT association with any of the outcomes.ConclusionsCollateral status does not modify the effect of pretreatment IVT on the efficacy and safety outcomes of EVT.

Current and Emerging Endovascular and Neurocritical Care Management Strategies in Large-Core Ischemic Stroke

“…Recent studies have evaluated the safety of tPA in the era of EVT. In a retrospective analysis of 398 patients enrolled in the Stroke Thrombectomy Aneurysm Registry (STAR) who had baseline ASPECTS ≤ 5, LVO, and underwent EVT, there was no difference in the rates of symptomatic intracerebral hemorrhage (sICH) between patients who received IV tPA and those who did not (13.1% vs. 16.9%, p = 0.306) [16]. In another propensity-matched analysis of 282 patients with acute ischemic stroke enrolled in the International Stroke Perfusion Imaging Registry (INSPIRE) who achieved complete reperfusion after IV tPA or thrombectomy, there was increased sICH in the IV-tPA-only group with an infarct core >30 mL compared to those with EVT (20% vs. 3%, p = 0.008); of note, the majority of the EVT group also received IV tPA [17].…”

The effect of intravenous thrombolysis on patients with successful thrombectomy depends on final reperfusion grade: A retrospective study

“…Recent studies have evaluated the interactions between IVT and baseline variables on MT outcomes such as occlusion site, 5 collateral status, 6 Alberta Stroke Program Early CT Score (ASPECTS), 7 in‐hospital treatment delay, 8 and initial MT techniques. 9 Meanwhile, final reperfusion grade, commonly evaluated by the modified Thrombolysis in Cerebral Infarction (mTICI) score, 10 might be another potentially relevant factor.…”