학술논문
Intravenous Thrombolysis Before Endovascular Treatment in Posterior Circulation Occlusions: A MR CLEAN Registry Study
Document Type
Academic Journal
Author
Knapen, Robrecht R.M.M.; Pirson, F. Anne V.; Langezaal, Lucianne C.M.; Brouwer, Josje; Majoie, Charles B.L.M.; Emmer, Bart J.; Vos, Jan-Albert; van Doormaal, Pieter-Jan; Yoo, Albert J.; Bruggeman, Agnetha A.E.; Lycklama à Nijeholt, Geert J.; van der Leij, Chirstiaan; van Oostenbrugge, Robert J.; van Zwam, Wim H.; Schonewille, Wouter J.; Dippel, Diederik W.J.; van der Lugt, Aad; Roos, Yvo B.W.E.M.; Boiten, Jelis; Jansen, Ivo G.H.; Mulder, Maxim J.H.L.; Goldhoorn, Robert-Jan B.; Compagne, Kars C.J.; Kappelhof, Manon; den Hartog, Sanne J.; Hinsenveld, Wouter H.; Dippel, Diederik W.J.; Roozenbeek, Bob; van der Lugt, Aad; Roos, Yvo B.W.E.M.; Wermer, Marieke J.H.; van Walderveen, Marianne A.A.; van Es, Adriaan C.G.M.; Staals, Julie; Hofmeijer, Jeannette; Martens, Jasper M.; Boiten, Jelis; de Bruijn, Sebastiaan F.; van Dijk, Lukas C.; Bart van der Worp, H.; Lo, Rob H.; van Dijk, Ewoud J.; Boogaarts, Hieronymus D.; de Vries, J.; de Kort, Paul L.M.; van Tuijl, Julia; Peluso, Jo P.; Fransen, Puck; van den Berg, Jan S.P.; van Hasselt, Boudewijn A.A.M.; Aerden, Leo A.M.; Dallinga, René J.; Uyttenboogaart, Maarten; Eschgi, Omid; Bokkers, Reinoud P.H.; Schreuder, Tobien H.C.M.L.; Heijboer, Roel J.J.; Keizer, Koos; Yo, Lonneke S.F.; den Hertog, Heleen M.; Sturm, Emiel J.C.; Brouwers, Paul J.A.M.; van Walderveen, Marianne A.A.; Sprengers, Marieke E.S.; Jenniskens, Sjoerd F.M.; van den Berg, René; Beenen, Ludo F.M.; Postma, Alida A.; Roosendaal, Stefan D.; van der Kallen, Bas F.W.; van den Wijngaard, Ido R.; van Es, Adriaan C.G.M.; Martens, Jasper M.; Yo, Lonneke S.F.; Bot, Joost; Meijer, Anton; Ghariq, Elyas; Bokkers, Reinoud P.H.; van Proosdij, Marc P.; Menno Krietemeijer, G.; Peluso, Jo P.; Boogaarts, Hieronymus D.; Lo, Rob; Dinkelaar, Wouter; Appelman, Auke P.A.; Hammer, Bas; Pegge, Sjoert; van der Hoorn, Anouk; Vinke, Saman; Cornelissen, Sandra; Brans, Rutger; Dippel, Diederik W.J.; van der Lugt, Aad; Roos, Yvo B.W.E.M.; Boiten, Jelis; Hofmeijer, Jeannette; Martens, Jasper M.; Bart van der Worp, H.; Lo, Rob H.; Hofmeijer, Jeannette; Zwenneke Flach, H.; Lingsma, Hester F.; el Ghannouti, Naziha; Sterrenberg, Martin; Pellikaan, Wilma; Sprengers, Rita; Elfrink, Marjan; Simons, Michelle; Vossers, Marjolein; de Meris, Joke; Vermeulen, Tamara; Geerlings, Annet; van Vemde, Gina; Simons, Tiny; Messchendorp, Gert; Nicolaij, Nynke; Bongenaar, Hester; Bodde, Karin; Kleijn, Sandra; Lodico, Jasmijn; Droste, Hanneke; Wollaert, Maureen; Verheesen, Sabrina; Jeurrissen, D.; Bos, Erna; Drabbe, Yvonne; Sandiman, Michelle; Aaldering, Nicoline; Zweedijk, Berber; Vervoort, Jocova; Ponjee, Eva; Romviel, Sharon; Kanselaar, Karin; Barning, Denn; Venema, Esmee; Chalos, Vicky; Geuskens, Ralph R.; van Straaten, Tim; Ergezen, Saliha; Harmsma, Roger R.M.; Muijres, Daan; de Jong, Anouk; Berkhemer, Olvert A.; Boers, Anna M.M.; Huguet, J.; Groot, P.F.C.; Mens, Marieke A.; van Kranendonk, Katinka R.; Treurniet, Kilian M.; Tolhuisen, Manon L.; Alves, Heitor; Weterings, Annick J.; Kirkels, Eleonora L.F.; Voogd, Eva J.H.F.; Schupp, Lieve M.; Collette, Sabine L.; Groot, Adrien E.D.; LeCouffe, Natalie E.; Konduri, Praneeta R.; Prasetya, Haryadi; Arrarte-Terreros, Nerea; Ramos, Lucas A.; Boodt, Nikki
Source
Stroke. Jan 04, 2024
Subject
Language
English
ISSN
0039-2499
Abstract
BACKGROUND:: The effectiveness of intravenous thrombolysis (IVT) before endovascular treatment (EVT) has been investigated in randomized trials and meta-analyses. These studies mainly concerned anterior circulation occlusions. We aimed to investigate clinical, technical, and safety outcomes of IVT before EVT in posterior circulation occlusions in a nationwide registry. METHODS:: Patients were included from the MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands), a nationwide, prospective, multicenter registry of patients with acute ischemic stroke due to a large intracranial vessel occlusion receiving EVT between 2014 and 2019. All patients with a posterior circulation occlusion were included. Primary outcome was a shift toward better functional outcome on the modified Rankin Scale at 90 days. Secondary outcomes were favorable functional outcome (modified Rankin Scale scores, 0–3), occurrence of symptomatic intracranial hemorrhages, successful reperfusion (extended Thrombolysis in Cerebral Ischemia ≥2B), first-attempt successful reperfusion, and mortality at 90 days. Regression analyses with adjustments based on univariable analyses and literature were applied. RESULTS:: A total of 248 patients were included, who received either IVT (n=125) or no IVT (n=123) before EVT. Results show no differences in a shift on the modified Rankin Scale (adjusted common odds ratio, 1.04 [95% CI, 0.61–1.76]). Although symptomatic intracranial hemorrhages occurred more often in the IVT group (4.8% versus 2.4%), regression analysis did not show a significant difference (adjusted odds ratio, 1.65 [95% CI, 0.33–8.35]). Successful reperfusion, favorable functional outcome, first-attempt successful reperfusion, and mortality did not differ between patients treated with and without IVT. CONCLUSIONS:: We found no significant differences in clinical, technical, and safety outcomes between patients with a large vessel occlusion in the posterior circulation treated with or without IVT before EVT. Our results are in line with the literature on the anterior circulation.