학술논문
Intravenous Alteplase is Associated with First Pass Effect in Stent-retriever but not ADAPT Thrombectomy: Post Hoc Analysis of the SKIP Study
Document Type
Original Paper
Author
Shigeta, Keigo; Suzuki, Kentaro; Matsumaru, Yuji; Takeuchi, Masataka; Morimoto, Masafumi; Kanazawa, Ryuzaburo; Takayama, Yohei; Kamiya, Yuki; Okubo, Seiji; Hayakawa, Mikito; Ishii, Norihiro; Koguchi, Yorio; Ota, Takahiro; Takigawa, Tomoji; Inoue, Masato; Naito, Hiromichi; Hirano, Teruyuki; Kato, Noriyuki; Ueda, Toshihiro; Akaji, Kazunori; Iguchi, Yasuyuki; Miki, Kazunori; Tsuruta, Wataro; Fujimoto, Shigeru; Enomoto, Masaya; Aoyama, Jiro; Nakano, Tomoyuki; Kimura, Kazumi
Source
Clinical Neuroradiology: Official Journal of the German, Austrian, and Swiss Societies of Neuroradiology. 32(1):153-162
Subject
Language
English
ISSN
1869-1439
1869-1447
1869-1447
Abstract
Purpose: To investigate the effect of alteplase, either combined with stent-retriever thrombectomy or a direct aspiration first pass technique (ADAPT), in patients with large-vessel occlusion stroke.Methods: This was a retrospective post hoc analysis of data from The Direct Mechanical Thrombectomy in Acute LVO Stroke (SKIP) study. Patients were divided into two groups according to the first-line thrombectomy technique: stent-retriever and ADAPT. Each group was further divided into two subgroups, namely MT and MT + alteplase. The procedural outcomes, such as first pass effect (FPE) ratio and number of passes, were evaluated. The clinical outcomes included mRS score at 3 months.Results: A total of 180 patients were included (116 in the stent-retriever group and 64 in the ADAPT group). No interaction was detected between the first-line technique and alteplase administration. In the stent-retriever group, after adjusting for factors associated with FPE, the adjusted odds ratio (95% confidence interval) of FPE of the MT + alteplase subgroup versus the MT subgroup was 3.57 (1.5–8.48) and in the ADAPT group it was 1.35 (0.37–4.91). With alteplase, the number of passes decreased with adjusted odds ratios of 0.59 (0.37–0.93) in the stent-retriever group but not in the ADAPT group. In both first-line technique groups, clinical outcomes did not differ between subgroups.Conclusion: In the SKIP study, alteplase administration was associated with increased FPE when combined with stent-retriever thrombectomy, but not with ADAPT. We found no differences in the clinical outcomes.