학술논문
Association of Intravenous Thrombolysis with Delayed Reperfusion After Incomplete Mechanical Thrombectomy
ORIGINAL ARTICLE
ORIGINAL ARTICLE
Document Type
Academic Journal
Author
Mujanovic, Adnan; Kammer, Christoph; Kurmann, Christoph C.; Grunder, Lorenz; Beyeler, Morin; Lang, Matthias F.; Piechowiak, Eike I.; Meinel, Thomas R.; Jung, Simon; Almiri, William; Pilgram-Pastor, Sara; Hoffmann, Angelika; Seiffge, David J.; Heldner, Mirjam R.; Dobrocky, Tomas; Mordasini, Pasquale; Arnold, Marcel; Gralla, Jan; Fischer, Urs; Kaesmacher, Johannes
Source
Clinical Neuroradiology. March 2023, Vol. 33 Issue 1, p87, 12 p.
Subject
Language
English
ISSN
1869-1439
Abstract
Introduction The value of intravenous thrombolysis (IVT) in patients eligible for mechanical thrombectomy (MT), who have been directly referred to a comprehensive stroke center, remains debated [1,2]. Most meta-analyses of [...]
Purpose Treatment of distal vessel occlusions causing incomplete reperfusion after mechanical thrombectomy (MT) is debated. We hypothesized that pretreatment with intravenous thrombolysis (IVT) may facilitate delayed reperfusion (DR) of residual vessel occlusions causing incomplete reperfusion after MT. Methods Retrospective analysis of patients with incomplete reperfusion after MT, defined as extended thrombolysis in cerebral infarction (eTICI) 2a-2c, and available perfusion follow-up imaging at 24[+ or -]12h after MT. DR was defined as absence of any perfusion deficit on time-sensitive perfusion maps, indicating the absence of any residual occlusion. The association of IVT with the occurrence of DR was evaluated using a logistic regression analysis adjusted for confounders. Sensitivity analyses based on IVT timing (time between IVT start and the occurrence incomplete reperfusion following MT) were performed. Results In 368 included patients (median age 73.7 years, 51.1% female), DR occurred in 225 (61.1%). Atrial fibrillation, higher eTICI grade, better collateral status and longer intervention-to-follow- up time were all associated with DR. IVT did not show an association with the occurrence of DR (aOR 0.80, 95% CI 0.44-1.46, even in time-sensitive strata, aOR 2.28 [95% CI 0.65-9.23] and aOR 1.53 [95% CI 0.52-4.73] for IVT to incomplete reperfusion following MT timing Conclusion A DR occurred in 60% of patients with incomplete MT at ~24h and did not seem to occur more often in patients receiving pretreatment IVT. Further research on potential associations of IVT and DR after MT is required. Keywords Ischemic stroke * Perfusion imaging * Outcome * Incomplete Reperfusion * tPA * Tissue-type plasminogen activator
Purpose Treatment of distal vessel occlusions causing incomplete reperfusion after mechanical thrombectomy (MT) is debated. We hypothesized that pretreatment with intravenous thrombolysis (IVT) may facilitate delayed reperfusion (DR) of residual vessel occlusions causing incomplete reperfusion after MT. Methods Retrospective analysis of patients with incomplete reperfusion after MT, defined as extended thrombolysis in cerebral infarction (eTICI) 2a-2c, and available perfusion follow-up imaging at 24[+ or -]12h after MT. DR was defined as absence of any perfusion deficit on time-sensitive perfusion maps, indicating the absence of any residual occlusion. The association of IVT with the occurrence of DR was evaluated using a logistic regression analysis adjusted for confounders. Sensitivity analyses based on IVT timing (time between IVT start and the occurrence incomplete reperfusion following MT) were performed. Results In 368 included patients (median age 73.7 years, 51.1% female), DR occurred in 225 (61.1%). Atrial fibrillation, higher eTICI grade, better collateral status and longer intervention-to-follow- up time were all associated with DR. IVT did not show an association with the occurrence of DR (aOR 0.80, 95% CI 0.44-1.46, even in time-sensitive strata, aOR 2.28 [95% CI 0.65-9.23] and aOR 1.53 [95% CI 0.52-4.73] for IVT to incomplete reperfusion following MT timing Conclusion A DR occurred in 60% of patients with incomplete MT at ~24h and did not seem to occur more often in patients receiving pretreatment IVT. Further research on potential associations of IVT and DR after MT is required. Keywords Ischemic stroke * Perfusion imaging * Outcome * Incomplete Reperfusion * tPA * Tissue-type plasminogen activator