TY - JOUR
T1 - Endovascular Treatment With or Without Prior Intravenous Alteplase for Acute Ischemic Stroke
AU - MR CLEAN Registry Investigators
AU - Chalos, Vicky
AU - LeCouffe, Natalie E.
AU - Uyttenboogaart, Maarten
AU - Lingsma, Hester F.
AU - Mulder, Maxim J. H. L.
AU - Venema, Esmee
AU - Treurniet, Kilian M.
AU - Eshghi, Omid
AU - van der Worp, H. Bart
AU - van der Lugt, Aad
AU - Roos, Yvo B. W. E. M.
AU - Majoie, Charles B. L. M.
AU - Dippel, Diederik W. J.
AU - Roozenbeek, Bob
AU - Coutinho, Jonathan M.
AU - van Oostenbrugge, Robert J.
AU - van Zwam, Wim H.
AU - Boiten, Jelis
AU - Vos, Jan Albert
AU - Jansen, Ivo G. H.
AU - Goldhoorn, Robert-Jan B.
AU - Schonewille, Wouter J.
AU - Wermer, Marieke J. H.
AU - on behalf of the MR CLEAN Registry Investigators
AU - van Walderveen, Marianne A. A.
AU - Staals, Julie
AU - Hofmeijer, Jeannette
AU - Martens, Jasper M.
AU - Lycklama à Nijeholt, Geert J.
AU - Emmer, Bart J.
AU - de Bruijn, Sebastiaan F.
AU - van Dijk, Lukas C.
AU - Lo, Rob H.
AU - van Dijk, Ewoud J.
AU - Boogaarts, Hieronymus D.
AU - de Kort, Paul L. M.
AU - Peluso, Jo J. P.
AU - van den Berg, Jan S. P.
AU - van Hasselt, Boudewijn A. A. M.
AU - Aerden, Leo A. M.
AU - Dallinga, René J.
AU - Schreuder, Tobien H. C. M. L.
AU - Heijboer, Roel J. J.
AU - Keizer, Koos
AU - Yo, Lonneke S. F.
AU - Sprengers, Marieke E. S.
AU - van den Berg, René
AU - Beenen, Ludo F. M.
AU - Roosendaal, Stefan D.
AU - Bot, Joseph C. J.
AU - Berkhemer, Olvert A.
PY - 2019/6/4
Y1 - 2019/6/4
N2 - Background It is unclear whether intravenous thrombolysis ( IVT ) with alteplase before endovascular treatment ( EVT ) is beneficial for patients with acute ischemic stroke caused by a large vessel occlusion. We compared clinical and procedural outcomes, safety, and workflow between patients treated with both IVT and EVT and those treated with EVT alone in routine clinical practice. Methods and Results Using multivariable regression, we evaluated the association of IVT + EVT with 90-day functional outcome (modified Rankin Scale), mortality, reperfusion, first-pass effect, and symptomatic intracranial hemorrhage in the MR CLEAN (Multicenter Randomised Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) Registry. Of 1485 patients, 1161 (78%) were treated with IVT + EVT , and 324 (22%) with EVT alone. Patients treated with IVT + EVT had atrial fibrillation less often (16% versus 44%) and had better pre-stroke modified Rankin Scale scores (pre-stroke modified Rankin Scale 0: 73% versus 52%) than those treated with EVT alone. Procedure time was shorter in the IVT + EVT group (median 62 versus 68 minutes). Nontransferred IVT + EVT patients had longer door-to-groin-puncture times (median 105 versus 94 minutes). IVT + EVT was associated with better functional outcome (adjusted common odds ratio 1.47; 95% CI : 1.10-1.96) and lower mortality (adjusted odds ratio 0.58; 95% CI : 0.40-0.82). Successful reperfusion, first-pass effect, and symptomatic intracranial hemorrhage did not differ between groups. Conclusions In this observational study, patients treated with IVT + EVT had better clinical outcomes than patients who received EVT alone. This finding may demonstrate a true benefit of IVT before EVT , but its interpretation is hampered by the possibility of residual confounding and selection bias. Randomized trials are required to properly assess the effect of IVT before EVT .
AB - Background It is unclear whether intravenous thrombolysis ( IVT ) with alteplase before endovascular treatment ( EVT ) is beneficial for patients with acute ischemic stroke caused by a large vessel occlusion. We compared clinical and procedural outcomes, safety, and workflow between patients treated with both IVT and EVT and those treated with EVT alone in routine clinical practice. Methods and Results Using multivariable regression, we evaluated the association of IVT + EVT with 90-day functional outcome (modified Rankin Scale), mortality, reperfusion, first-pass effect, and symptomatic intracranial hemorrhage in the MR CLEAN (Multicenter Randomised Controlled Trial of Endovascular Treatment for Acute Ischemic Stroke in The Netherlands) Registry. Of 1485 patients, 1161 (78%) were treated with IVT + EVT , and 324 (22%) with EVT alone. Patients treated with IVT + EVT had atrial fibrillation less often (16% versus 44%) and had better pre-stroke modified Rankin Scale scores (pre-stroke modified Rankin Scale 0: 73% versus 52%) than those treated with EVT alone. Procedure time was shorter in the IVT + EVT group (median 62 versus 68 minutes). Nontransferred IVT + EVT patients had longer door-to-groin-puncture times (median 105 versus 94 minutes). IVT + EVT was associated with better functional outcome (adjusted common odds ratio 1.47; 95% CI : 1.10-1.96) and lower mortality (adjusted odds ratio 0.58; 95% CI : 0.40-0.82). Successful reperfusion, first-pass effect, and symptomatic intracranial hemorrhage did not differ between groups. Conclusions In this observational study, patients treated with IVT + EVT had better clinical outcomes than patients who received EVT alone. This finding may demonstrate a true benefit of IVT before EVT , but its interpretation is hampered by the possibility of residual confounding and selection bias. Randomized trials are required to properly assess the effect of IVT before EVT .
UR - http://www.scopus.com/inward/record.url?scp=85067315956&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85067315956&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/31140355
U2 - https://doi.org/10.1161/JAHA.118.011592
DO - https://doi.org/10.1161/JAHA.118.011592
M3 - Article
C2 - 31140355
SN - 2047-9980
VL - 8
SP - e011592
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 11
M1 - e011592
ER -