TY - JOUR
T1 - Intravenous Thrombolysis 4.5–9 Hours After Stroke Onset
T2 - A Cohort Study from the TRISP Collaboration
AU - Altersberger, Valerian L.
AU - Sibolt, Gerli
AU - Enz, Lukas S.
AU - Hametner, Christian
AU - Scheitz, Jan F.
AU - Henon, Hilde
AU - Bigliardi, Guido
AU - Strambo, Davide
AU - Martinez-Majander, Nicolas
AU - Stolze, Lotte J.
AU - Heldner, Mirjam R.
AU - Grisendi, Ilaria
AU - Jovanovic, Dejana R.
AU - Bejot, Yannick
AU - Pezzini, Alessandro
AU - Leker, Ronen R.
AU - Kägi, Georg
AU - Wegener, Susanne
AU - Cereda, Carlo W.
AU - Ntaios, Georges
AU - de Marchis, Gian Marco
AU - Bonati, Leo H.
AU - Psychogios, Marios
AU - Lyrer, Philippe
AU - Räty, Silja
AU - Tiainen, Marjaana
AU - Wouters, Anke
AU - Caparros, François
AU - Heyse, Miriam
AU - Erdur, Hebun
AU - Padjen, Visnja
AU - Zedde, Marialuisa
AU - Arnold, Marcel
AU - Nederkoorn, Paul J.
AU - Michel, Patrik
AU - Zini, Andrea
AU - Cordonnier, Charlotte
AU - Nolte, Christian H.
AU - Ringleb, Peter A.
AU - Curtze, Sami
AU - the TRISP collaborators
AU - Engelter, Stefan T.
AU - Gensicke, Henrik
N1 - Funding Information: None. Open access funding provided by Universitat Basel. Publisher Copyright: © 2023 The Authors. Annals of Neurology published by Wiley Periodicals LLC on behalf of American Neurological Association.
PY - 2023/8
Y1 - 2023/8
N2 - Objective: To investigate the safety and effectiveness of intravenous thrombolysis (IVT) >4.5–9 hours after stroke onset, and the relevance of advanced neuroimaging for patient selection. Methods: Prospective multicenter cohort study from the ThRombolysis in Ischemic Stroke Patients (TRISP) collaboration. Outcomes were symptomatic intracranial hemorrhage, poor 3-month functional outcome (modified Rankin scale 3–6) and mortality. We compared: (i) IVT >4.5–9 hours versus 0–4.5 hours after stroke onset and (ii) within the >4.5–9 hours group baseline advanced neuroimaging (computed tomography perfusion, magnetic resonance perfusion or magnetic resonance diffusion-weighted imaging fluid-attenuated inversion recovery) versus non-advanced neuroimaging. Results: Of 15,827 patients, 663 (4.2%) received IVT >4.5–9 hours and 15,164 (95.8%) within 4.5 hours after stroke onset. The main baseline characteristics were evenly distributed between both groups. Time of stroke onset was known in 74.9% of patients treated between >4.5 and 9 hours. Using propensity score weighted binary logistic regression analysis (onset-to-treatment time >4.5–9 hours vs onset-to-treatment time 0–4.5 hours), the probability of symptomatic intracranial hemorrhage (ORadjusted 0.80, 95% CI 0.53–1.17), poor functional outcome (ORadjusted 1.01, 95% CI 0.83–1.22), and mortality (ORadjusted 0.80, 95% CI 0.61–1.04) did not differ significantly between both groups. In patients treated between >4.5 and 9 hours, the use of advanced neuroimaging was associated with a 50% lower mortality compared with non-advanced imaging only (9.9% vs 19.7%; ORadjusted 0.51, 95% CI 0.33–0.79). Interpretation: This study showed no evidence in difference of symptomatic intracranial hemorrhage, poor outcome, and mortality in selected stroke patients treated with IVT between >4.5 and 9 hours after stroke onset compared with those treated within 4.5 hours. Advanced neuroimaging for patient selection was associated with lower mortality. ANN NEUROL 2023;94:309–320.
AB - Objective: To investigate the safety and effectiveness of intravenous thrombolysis (IVT) >4.5–9 hours after stroke onset, and the relevance of advanced neuroimaging for patient selection. Methods: Prospective multicenter cohort study from the ThRombolysis in Ischemic Stroke Patients (TRISP) collaboration. Outcomes were symptomatic intracranial hemorrhage, poor 3-month functional outcome (modified Rankin scale 3–6) and mortality. We compared: (i) IVT >4.5–9 hours versus 0–4.5 hours after stroke onset and (ii) within the >4.5–9 hours group baseline advanced neuroimaging (computed tomography perfusion, magnetic resonance perfusion or magnetic resonance diffusion-weighted imaging fluid-attenuated inversion recovery) versus non-advanced neuroimaging. Results: Of 15,827 patients, 663 (4.2%) received IVT >4.5–9 hours and 15,164 (95.8%) within 4.5 hours after stroke onset. The main baseline characteristics were evenly distributed between both groups. Time of stroke onset was known in 74.9% of patients treated between >4.5 and 9 hours. Using propensity score weighted binary logistic regression analysis (onset-to-treatment time >4.5–9 hours vs onset-to-treatment time 0–4.5 hours), the probability of symptomatic intracranial hemorrhage (ORadjusted 0.80, 95% CI 0.53–1.17), poor functional outcome (ORadjusted 1.01, 95% CI 0.83–1.22), and mortality (ORadjusted 0.80, 95% CI 0.61–1.04) did not differ significantly between both groups. In patients treated between >4.5 and 9 hours, the use of advanced neuroimaging was associated with a 50% lower mortality compared with non-advanced imaging only (9.9% vs 19.7%; ORadjusted 0.51, 95% CI 0.33–0.79). Interpretation: This study showed no evidence in difference of symptomatic intracranial hemorrhage, poor outcome, and mortality in selected stroke patients treated with IVT between >4.5 and 9 hours after stroke onset compared with those treated within 4.5 hours. Advanced neuroimaging for patient selection was associated with lower mortality. ANN NEUROL 2023;94:309–320.
UR - http://www.scopus.com/inward/record.url?scp=85159213047&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ana.26669
DO - https://doi.org/10.1002/ana.26669
M3 - Article
C2 - 37114466
SN - 0364-5134
VL - 94
SP - 309
EP - 320
JO - Annals of neurology
JF - Annals of neurology
IS - 2
ER -