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Benefit of Intravenous Alteplase before Thrombectomy Depends on ASPECTS

Authors :
Gabriel Broocks
Jeremy J. Heit
Gabriella M. Kuraitis
Lukas Meyer
Noel van Horn
Matthias Bechstein
Christian Thaler
Soren Christensen
Michael Mlynash
Maarten G. Lansberg
Andre Kemmling
Gerhard Schön
Gregory Albers
Jens Fiehler
Max Wintermark
Tobias D. Faizy
Source :
Annals of neurologyReferences. 92(4)
Publication Year :
2022

Abstract

Baseline variables could be used to guide the administration of additional intravenous alteplase (IVT) before mechanical thrombectomy (MT). The aim of this study was to determine how baseline imaging and demographic parameters modify the effect of IVT on clinical outcomes in patients with ischemic stroke due to large vessel occlusion.Multicenter retrospective cohort study of ischemic stroke patients triaged by multimodal-CT undergoing MT treatment after direct admission to an MT-eligible center. Inverse-probability weighting analysis (IPW) was used to assess the treatment effect of IVT adjusted for baseline variables. Multivariable logistic regression analysis with IPW-weighting and interaction terms for IVT was performed to predict functional independence (mRS 0-2 at 90-days).720 patients were included, of which 366 (51%) received IVT. In IPW, the treatment effect of IVT on outcome (mRS 0-2) distinctively varied according to the ASPECTS subgroup (ASPECTS 9-10: +15%, ASPECTS 6-8: +7%, ASPECTS6: -11%). In multivariable logistic regression analysis, IVT was independently associated with functional independence (aOR: 1.57, 95% CI: 1.16-2.14, p = 0.003) and the interaction term was significant for ASPECTS and IVT revealing that IVT was only significantly associated with better outcomes in patients with higher ASPECTS. No other significant baseline variable interaction terms were identified.ASPECTS was the only baseline variable that showed a significant interaction with IVT for outcome prediction. Use of IVT prior to MT in patients with an ASPECTS of6 was not associated with a treatment benefit and should be considered carefully. ANN NEUROL 2022;92:588-595.

Details

ISSN :
15318249
Volume :
92
Issue :
4
Database :
OpenAIRE
Journal :
Annals of neurologyReferences
Accession number :
edsair.doi.dedup.....89b0c40ecf6bcf18cde4b6bd1dffcd71