TY - JOUR
T1 - Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone
AU - van Kranendonk, Katinka R.
AU - Kappelhof, Manon
AU - Bruggeman, Agnetha A. E.
AU - Rinkel, Leon A.
AU - Treurniet, Kilian M.
AU - Lecouffe, Natalie
AU - Emmer, Bart J.
AU - Coutinho, Jonathan M.
AU - Wolff, Lennard
AU - van Zwam, Wim H.
AU - van Oostenbrugge, Robert J.
AU - van der Lugt, Aad
AU - Dippel, Diederik W. J.
AU - Roos, Yvo B. W. E. M.
AU - Marquering, Henk A.
AU - Majoie, Charles B. L. M.
N1 - Funding Information: CBLM reports grants from CVON/Dutch Heart Foundation and Stryker (related and paid to institution), and TWIN Foundation, European Commission, Health Evaluation Netherlands (outside the submitted work and paid to institution); and is shareholder of Nico.lab. HAM is cofounder and shareholder of Nico.lab. DWJD and Van der Lugt report grants from Dutch Heart Foundation, Dutch Brain Foundation, Health Holland, Stryker, Medtronic Penumbra, Cerenovus and Thrombolytic Science Inc, all paid to the institution. YDWR is shareholder of Nico.lab. JMC reports research support from Medtronic (paid to institution). All other authors have nothing to disclose. Funding Information: MR CLEAN NO_IV was funded through the CONTRAST consortium, which acknowledges the support from the Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation (CVON2015-01: CONTRAST), and from the Brain Foundation Netherlands (HA2015.01.06). The collaboration project is additionally financed by the Ministry of Economic Affairs by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships (LSHM17016). This work was funded in part through unrestricted funding by Stryker, Medtronic and Cerenovus. Publisher Copyright: © Author(s) (or their employer(s)) 2022.
PY - 2022
Y1 - 2022
N2 - Background: Intravenous alteplase treatment (IVT) for acute ischemic stroke carries a risk of intracranial hemorrhage (ICH). However, reperfusion of an occluded vessel itself may contribute to the risk of ICH. We determined whether IVT and reperfusion are associated with ICH or its volume in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN)-NO IV trial. Methods: The MR CLEAN-NO IV trial randomized patients with acute ischemic stroke due to large vessel occlusion to receive either IVT followed by endovascular treatment (EVT) or EVT alone. ICH was classified according to the Heidelberg bleeding classification on follow-up MRI or CT approximately 8 hours-7 days after stroke. Hemorrhage volume was measured with ITK-snap. Successful reperfusion was defined as extended Thrombolysis In Cerebral Infarction (eTICI) score of 2b-3. Multinomial and binary adjusted logistic regression were used to determine the association of IVT and reperfusion with ICH subtypes. Results: Of 539 included patients, 173 (32%) developed ICH and 30 suffered from symptomatic ICH (sICH) (6%). Of the patients with ICH, 102 had hemorrhagic infarction, 47 had parenchymal hematoma, 44 had SAH, and six had other ICH. Reperfusion was associated with a decreased risk of SAH, and IVT was not associated with SAH (eTICI 2b-3: Adjusted OR 0.45, 95% CI 0.21 to 0.97; EVT without IVT: OR 1.6, 95% CI 0.91 to 2.8). Reperfusion status and IVT were not associated with overall ICH, hemorrhage volume, and sICH (sICH: EVT without IVT, OR 0.96, 95% CI 0.41 to 2.25; eTICI 2b-3, OR 0.49, 95% CI 0.23 to 1.05). Conclusion: Neither IVT administration before EVT nor successful reperfusion after EVT were associated with ICH, hemorrhage volume, and sICH. SAH occurred more often in patients for whom successful reperfusion was not achieved.
AB - Background: Intravenous alteplase treatment (IVT) for acute ischemic stroke carries a risk of intracranial hemorrhage (ICH). However, reperfusion of an occluded vessel itself may contribute to the risk of ICH. We determined whether IVT and reperfusion are associated with ICH or its volume in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN)-NO IV trial. Methods: The MR CLEAN-NO IV trial randomized patients with acute ischemic stroke due to large vessel occlusion to receive either IVT followed by endovascular treatment (EVT) or EVT alone. ICH was classified according to the Heidelberg bleeding classification on follow-up MRI or CT approximately 8 hours-7 days after stroke. Hemorrhage volume was measured with ITK-snap. Successful reperfusion was defined as extended Thrombolysis In Cerebral Infarction (eTICI) score of 2b-3. Multinomial and binary adjusted logistic regression were used to determine the association of IVT and reperfusion with ICH subtypes. Results: Of 539 included patients, 173 (32%) developed ICH and 30 suffered from symptomatic ICH (sICH) (6%). Of the patients with ICH, 102 had hemorrhagic infarction, 47 had parenchymal hematoma, 44 had SAH, and six had other ICH. Reperfusion was associated with a decreased risk of SAH, and IVT was not associated with SAH (eTICI 2b-3: Adjusted OR 0.45, 95% CI 0.21 to 0.97; EVT without IVT: OR 1.6, 95% CI 0.91 to 2.8). Reperfusion status and IVT were not associated with overall ICH, hemorrhage volume, and sICH (sICH: EVT without IVT, OR 0.96, 95% CI 0.41 to 2.25; eTICI 2b-3, OR 0.49, 95% CI 0.23 to 1.05). Conclusion: Neither IVT administration before EVT nor successful reperfusion after EVT were associated with ICH, hemorrhage volume, and sICH. SAH occurred more often in patients for whom successful reperfusion was not achieved.
KW - Hemorrhage
KW - Stroke
KW - Thrombectomy
KW - Thrombolysis
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85145083041&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/36396434
UR - http://www.scopus.com/inward/record.url?scp=85145083041&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/jnis-2022-019569
DO - https://doi.org/10.1136/jnis-2022-019569
M3 - Article
C2 - 36396434
SN - 1759-8478
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
M1 - 019569
ER -