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Supplemental Material, sj-docx-1-ctn-10.1177_2514183X211017363 for Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy by Johannes Kaesmacher, Giovanni Peschi, Nuran Abdullayev, Basel Maamari, Tomas Dobrocky, Jan Vynckier, Eike Piechowiak, Raoul Pop, Daniel Behme, Peter B Sporns, Hanna Styczen, Pekka Virtanen, Lukas Meyer, Thomas R Meinel, Daniel Cantré, Christoph Kabbasch, Volker Maus, Johanna Pekkola, Sebastian Fischer, Anca Hasiu, Alexander Schwarz, Moritz Wildgruber, David J Seiffge, Sönke Langner, Nicolas Martinez-Majander, Alexander Radbruch, Marc Schlamann, Dan Mihoc, Rémy Beaujeux, Daniel Strbian, Jens Fiehler, Pasquale Mordasini, Jan Gralla and Urs Fischer in Clinical and Translational Neuroscience

BACKGROUND AND PURPOSE Data on safety and efficacy of intra-arterial (IA) fibrinolytics as adjunct to mechanical thrombectomy (MT) are sparse. METHODS INtra-arterial FIbriNolytics In ThrombectomY (INFINITY) is a retrospective multi-center observational registry of consecutive patients with anterior circulation large-vessel occlusion ischemic stroke treated with MT and adjunctive administration of IA fibrinolytics (alteplase [tissue plasminogen activator, tPA] or urokinase [UK]) at 10 European centers. Primary outcome was the occurrence of symptomatic intracranial hemorrhage (sICH) according to the European Cooperative Acute Stroke Study II definition. Secondary outcomes were mortality and modified Rankin Scale (mRS) scores at 3 months. RESULTS Of 5,612 patients screened, 311 (median age, 74 years; 44.1% female) received additional IA after or during MT (194 MT+IA tPA, 117 MT+IA UK). IA fibrinolytics were mostly administered for rescue of thrombolysis in cerebral infarction (TICI) 0-2b after MT (80.4%, 250/311). sICH occurred in 27 of 308 patients (8.8%), with an increased risk in patients with initial TICI0/1 (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1 to 5.0 per TICI grade decrease) or in those with intracranial internal carotid artery occlusions (aOR, 3.7; 95% CI, 1.2 to 12.5). In patients with attempted rescue of TICI0-2b and available angiographic follow-up, 116 of 228 patients (50.9%) showed any angiographic reperfusion improvement after IA fibrinolytics, which was associated with mRS ≤2 (aOR, 3.1; 95% CI, 1.4 to 6.9). CONCLUSIONS Administration of IA fibrinolytics as adjunct to MT is performed rarely, but can improve reperfusion, which is associated with better outcomes. Despite a selection bias, an increased risk of sICH seems possible, which underlines the importance of careful patient selection.