Post-Thrombolysis Recanalization in Stroke Referrals for Thrombectomy

Seners, Pierre; Turc, Guillaume; Naggara, Olivier; Hénon, Hilde; Piotin, Michel; Arquizan, Caroline; Cho, Tae-Hee; Narata, Ana-Paula; Lapergue, Bertrand; Richard, Sébastien; Legrand, Laurence; Bricout, Nicolas; Blanc, Raphaël; Dargazanli, Cyril; Gory, Benjamin; Debiais, Séverine; Tisserand, Marie; Bracard, Serge; Leclerc, Xavier; Obadia, Michaël; Costalat, Vincent; Berner, Lise-Prune; Cottier, Jean‐Philippe; Consoli, Arturo; Ducrocq, Xavier; Mas, Jean‐Louis; Oppenheim, Catherine; Baron, Jean‐Claude; Abrivard, Marie; Alamowitch, Sonia; Hassen, Wagih Ben; Berthezène, Yves; Blanc‐Lasserre, Karine; Boulin, A.; Boulouis, Grégoire; Bouly, S.; Bourdain, Frédéric; Calvet, D.; Charron, Vladimir; Chbicheb, Mohamed; Condette–Auliac, S.; Corabianu, Ovide; Cordonnier, Charlotte; Coskun, Oguzhan; Broucker, T. de; Decroix, Jean‐Pierre; Maria, Federico Di; Évrard, Serge; Fissellier, Mathieu; Girard, Isabelle; Lalu, T.; Coz, P. Le; Guen, Morgan Le; Ille, Olivier; Leys, Didier; Magni, Christophe; Manchon, Éric; Mazighi, Mikaël; Mounier‐Véhier, F.; Moynier, Marinette; Muresan, Ioan-Paul; Nighoghossian, Norbert; Ong, Elodie; Özsancak, Canan; Philippeau, Frédéric; Pico, Fernando; Rodesch, Georges; Rosolacci, Thierry; Sabben, Candice; Sablot, Denis; Tassan, Philippe; Tchikviladzé, Maya; Turjman, Francis; Vallet, Anne‐Evelyne; Wang, Adrien; Zins, Marc; Zuber, Mathieu

doi:10.1161/strokeaha.118.022335

Cited by 47 publications

(60 citation statements)

References 21 publications

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“…Several factors may explain such higher benefits from bridging for more proximal occlusions. First, occlusion site is a wellknown strong predictor of post-thrombolysis recanalization, [20][21][22] a factor strongly associated with reduced odds of early neurological deterioration 23,24 and poor outcome. 25 Second, the known higher procedural risks, including vessel perforation, with distal occlusions 26 could partly explain our finding of an association between bridging therapy and higher odds of any ICH and sICH for M2 occlusions.…”

Section: Discussionmentioning

confidence: 99%

Bridging Therapy or IV Thrombolysis in Minor Stroke with Large Vessel Occlusion

Seners

Perrin

Lapergue

et al. 2020

Annals of Neurology

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Objective Whether bridging therapy (intravenous thrombolysis [IVT] followed by endovascular treatment) is superior to IVT alone in minor stroke with large vessel occlusion (LVO) is unknown. Methods Multicentric retrospective observational study including, in intention‐to‐treat, consecutive IVT‐treated minor strokes (National Institutes of Health Stroke Scale [NIHSS] ≤ 5) with LVO, with or without additional mechanical thrombectomy. Propensity‐score (inverse probability of treatment weighting) was used to reduce baseline between‐groups differences. The primary outcome was excellent outcome, that is, modified Rankin score 0 to 1 at 3 months follow‐up. Results Overall, 598 patients were included (214 and 384 in the bridging therapy and IVT groups, respectively). Following propensity‐score weighting, the distribution of baseline clinical and radiological variables was similar across the two patient groups. Compared with IVT alone, bridging therapy was not associated with excellent outcome (odds ratio [OR] = 0.96; 95% confidence interval [CI] = 0.75–1.24; p = 0.76), but was associated with symptomatic intracranial hemorrhage (OR = 3.01; 95% CI = 1.77–5.11; p < 0.0001). Occlusion site was a strong modifier of the effect of bridging therapy on outcome (pinteraction < 0.0001), with bridging therapy associated with higher odds of excellent outcome in proximal M1 (OR = 3.26; 95% CI = 1.67–6.35; p = 0.0006) and distal M1 (OR = 1.69; 95% CI = 1.01–2.82; p = 0.04) occlusions, but with lower odds of excellent outcome for M2 (OR = 0.53; 95% CI = 0.38–0.75; p = 0.0003) occlusions. Bridging therapy was associated with higher rates of symptomatic intracranial hemorrhage in M2 occlusions only (OR = 4.40; 95% CI = 2.20–8.83; p < 0.0001). Interpretation Although overall outcomes were similar in intended bridging therapy as compared to intended IVT alone in minor strokes with LVO, our results suggest that intended bridging therapy may be beneficial in M1 occlusions, whereas the benefit–risk profile may favor IVT alone in M2 occlusions. ANN NEUROL 2020 ANN NEUROL 2020;88:160–169

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Section: Discussionmentioning

confidence: 99%

Bridging Therapy or IV Thrombolysis in Minor Stroke with Large Vessel Occlusion

Seners

Perrin

Lapergue

et al. 2020

Annals of Neurology

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“…bridging vs direct mechanical thrombectomy patients will only cover patients, who had persistent occlusions on the first angiography run, or did not clinically improve after IVT, respectively. The lack of a significant difference or interaction thus does not imply that pre-interventional IVT is not beneficial in this subcohort of patients, because at least 10%–20% of patients will reperfuse before endovascular thrombectomy [46, 47], which has been associated with better clinical outcomes.…”

Section: Limitationsmentioning

confidence: 99%

Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry

et al. 2019

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Background and purpose If patients presenting with large vessel occlusions (LVO) and mild symptoms should be treated with endvoascular treatment (EVT) remains unclear. Aims of this study were (1) assessing the safety and technical efficacy of EVT in patients with NIHSS < 8 as opposed to a comparison group of patients presenting with NIHSS ≥ 8 and (2) evaluation of the clinical effect of reperfusion in patients with NIHSS < 8. Methods Patients included into the retrospective multicenter BEYOND-SWIFT registry (NCT03496064) were analyzed. Clinical effect of achieving successful reperfusion (defined as modified Thrombolysis in Cerebral Infarction grade 2b/3) in patients presenting with NIHSS < 8 ( N = 193) was evaluated using multivariable logistic regression analyses (displayed as adjusted Odds Ratios, aOR and 95% confidence intervals, 95%-CI). Primary outcome was excellent functional outcome (modified Rankin Scale, mRS 0–1) at day 90. Safety and efficacy of mechanical thrombectomy in patients with NIHSS < 8 was compared to patients presenting with NIHSS ≥ 8 ( N = 1423). Results Among patients with NIHSS < 8 ( N = 193, 77/193, 39.9% receiving pre-interventional IV-tPA), successful reperfusion was significantly related to mRS 0–1 (aOR 3.217, 95%-CI 1.174–8.816) and reduced the chances of non-hemorrhagic neurological worsening (aOR 0.194, 95%-CI 0.050–0.756) after adjusting for prespecified confounders. In interaction analyses, the relative merits of achieving successful reperfusion were mostly comparable between patients presenting with NIHSS < 8 and NIHSS ≥ 8 as evidenced by non-significantly different aOR. Interventional safety and efficacy metrics were similar between patients with NIHSS < 8 and NIHSS ≥ 8. Conclusions Achieving successful reperfusion is beneficial in patients with persisting LVO presenting with NIHSS < 8 and reduces the risk of non-hemorrhagic neurological worsening. Electronic supplementary material The online version of this article (10.1007/s00415-018-09172-1) contains supplementary material, which is available to authorized users.

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“…In this study, a larger number of patients received direct thrombectomy without intravenous rtPA treatment (89.6%) than those of previous studies, as all patients had been confirmed with proximal large vessel occlusions, which are predicted to occur at significantly lower rates of thrombolytic recanalization (23). The median time of stroke onset to groin puncture, and time to reperfusion were similar to the REVASCAT trial (250 vs. 269 min and 330 vs. 355 min, respectively) (5).…”

Section: Discussionmentioning

confidence: 88%

Severe Stroke Patients With Left-Sided Occlusion of the Proximal Anterior Circulation Benefit More From Thrombectomy

Chu

Zhao

et al. 2019

Front. Neurol.

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Background and Purpose: Endovascular thrombectomy improves the functional independence of patients with proximal anterior circulation occlusion. However, a subset of patients fail to benefit from thrombectomy procedures, the reasons for which remain poorly defined. In this study, we investigated whether the effectiveness of thrombectomy was affected by left- or right-sided occlusion among patients with similar stroke severities. Methods: Patients with proximal anterior circulation occlusion (internal carotid or M1 of middle cerebral artery) treated with the Solitaire stent retriever within 8 h of the onset of acute ischemic stroke were enrolled from the Yijishan Hospital of Wannan Medical College. Stroke severity was measured using the National Institutes of Health Stroke Scale (NIHSS) on admission. The functional outcomes were assessed using the modified Rankin scale (mRS) at 90 days. Results: We enrolled 174 patients including 90 left-sided occlusion and 84 right-sided occlusion. The NIHSS scores on admission were higher in the left-sided (median, 19; interquartile range, 16 to 20) compared to the right-sided occlusion group (median, 15, interquartile range, 13 to 18) ( P < 0.001). Following adjustment for potential risk factors, patients with left-sided occlusion had higher rates of functional independence (mRS ≤ 2) and lower rates of mortality (mRS = 6) compared to the right-sided occlusion patients (39.5 vs. 19.6% and 28.9 vs. 47.8%, respectively) in the severe stroke group (NIHSS ≥ 15). Conclusions: In severe stroke patients with proximal anterior circulation occlusion, stent retriever thrombectomy within 8 h of the onset of symptoms provides more benefits to left-sided occlusion.

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Post-Thrombolysis Recanalization in Stroke Referrals for Thrombectomy

Cited by 47 publications

References 21 publications

Bridging Therapy or IV Thrombolysis in Minor Stroke with Large Vessel Occlusion

Bridging Therapy or IV Thrombolysis in Minor Stroke with Large Vessel Occlusion

Clinical effect of successful reperfusion in patients presenting with NIHSS < 8: data from the BEYOND-SWIFT registry

Severe Stroke Patients With Left-Sided Occlusion of the Proximal Anterior Circulation Benefit More From Thrombectomy

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