Titre
Outcomes of Bridging Intravenous Thrombolysis Versus Endovascular Therapy Alone in Late-Window Acute Ischemic Stroke.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Demeestere, J.
Auteure/Auteur
Qureshi, M.M.
Auteure/Auteur
Vandewalle, L.
Auteure/Auteur
Wouters, A.
Auteure/Auteur
Strbian, D.
Auteure/Auteur
Nogueira, R.G.
Auteure/Auteur
Nagel, S.
Auteure/Auteur
Yamagami, H.
Auteure/Auteur
Puetz, V.
Auteure/Auteur
Abdalkader, M.
Auteure/Auteur
Haussen, D.C.
Auteure/Auteur
Mohammaden, M.H.
Auteure/Auteur
Möhlenbruch, M.A.
Auteure/Auteur
Olivé-Gadea, M.
Auteure/Auteur
Winzer, S.
Auteure/Auteur
Ribo, M.
Auteure/Auteur
Michel, P.
Auteure/Auteur
Marto, J.P.
Auteure/Auteur
Tanaka, K.
Auteure/Auteur
Yoshimura, S.
Auteure/Auteur
Martinez-Majander, N.
Auteure/Auteur
Caparros, F.
Auteure/Auteur
Henon, H.
Auteure/Auteur
Tomppo, L.
Auteure/Auteur
Dusart, A.
Auteure/Auteur
Bellante, F.
Auteure/Auteur
Ramos, J.N.
Auteure/Auteur
Jesser, J.
Auteure/Auteur
Sheth, S.A.
Auteure/Auteur
Ortega-Gutiérrez, S.
Auteure/Auteur
Siegler, J.E.
Auteure/Auteur
Nannoni, S.
Auteure/Auteur
Kaesmacher, J.
Auteure/Auteur
Dobrocky, T.
Auteure/Auteur
Salazar-Marioni, S.
Auteure/Auteur
Farooqui, M.
Auteure/Auteur
Virtanen, P.
Auteure/Auteur
Ventura, R.
Auteure/Auteur
Zaidi, S.F.
Auteure/Auteur
Castonguay, A.C.
Auteure/Auteur
Uchida, K.
Auteure/Auteur
Puri, A.S.
Auteure/Auteur
Sakai, N.
Auteure/Auteur
Toyoda, K.
Auteure/Auteur
Farzin, B.
Auteure/Auteur
Masoud, H.E.
Auteure/Auteur
Klein, P.
Auteure/Auteur
Bui, J.
Auteure/Auteur
Rizzo, F.
Auteure/Auteur
Kaiser, DPO
Auteure/Auteur
Desfontaines, P.
Auteure/Auteur
Strambo, D.
Auteure/Auteur
Cordonnier, C.
Auteure/Auteur
Lin, E.
Auteure/Auteur
Ringleb, P.A.
Auteure/Auteur
Roy, D.
Auteure/Auteur
Zaidat, O.O.
Auteure/Auteur
Fischer, U.
Auteure/Auteur
Raymond, J.
Auteure/Auteur
Lemmens, R.
Auteure/Auteur
Nguyen, T.N.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
1524-4628
Statut éditorial
Publié
Date de publication
2024-07
Volume
55
Numéro
7
Première page
1767
Dernière page/numéro d’article
1775
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study ; Comparative Study
Publication Status: ppublish
Publication Status: ppublish
Résumé
Studies comparing bridging intravenous thrombolysis (IVT) with direct endovascular therapy (EVT) in patients with acute ischemic stroke who present late are limited. We aimed to compare the clinical outcomes and safety of bridging IVT in patients with acute ischemic stroke due to anterior circulation large vessel occlusion who underwent EVT 6 to 24 hours after time last known well.
We enrolled patients with anterior circulation large vessel occlusion stroke and a National Institutes of Health Stroke Scale score of ≥6 from 20 centers across 10 countries in the multicenter retrospective CLEAR study (CT for Late Endovascular Reperfusion) between January 2014 and May 2022. We used inverse probability of treatment weighting modeling adjusted for clinical and imaging confounders to compare functional outcomes, reperfusion success, symptomatic intracranial hemorrhage, and mortality between EVT patients with and without prior IVT.
Of 5098 patients screened for eligibility, we included 2749 patients, of whom 549 received bridging IVT before EVT. The timing of IVT was not recorded. Witnessed stroke onset and transfer rates were higher in the bridging IVT group (25% versus 12% and 77% versus 55%, respectively, P value for both <0.0001), and time intervals between stroke onset and treatment were shorter (time last known well-start of EVT median 560 minutes [interquartile range, 432-791] versus 724 minutes [interquartile range, 544-912]; P<0.0001). After adjustment for confounders, there was no difference in functional outcome at 3 months (adjusted common odds ratio for modified Rankin Scale shift, 1.03 [95% CI, 0.89-1.19]; P=0.72) or successful reperfusion (adjusted odds ratio, 1.19 [95% CI, 0.81-1.75]; P=0.39). There were no safety concerns associated with bridging IVT versus direct EVT (symptomatic intracranial hemorrhage: adjusted odds ratio, 0.75 [95% CI, 0.38-1.48]; P=0.40; mortality: adjusted odds ratio, 1.14 [95% CI, 0.89-1.46]; P=0.31). Results were unchanged when the analysis was limited to patients who received IVT >6 hours after last known well.
In patients with an anterior circulation large vessel occlusion stroke who underwent EVT 6 to 24 hours from last known well, bridging IVT was not associated with a difference in outcomes compared with direct EVT.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04096248.
We enrolled patients with anterior circulation large vessel occlusion stroke and a National Institutes of Health Stroke Scale score of ≥6 from 20 centers across 10 countries in the multicenter retrospective CLEAR study (CT for Late Endovascular Reperfusion) between January 2014 and May 2022. We used inverse probability of treatment weighting modeling adjusted for clinical and imaging confounders to compare functional outcomes, reperfusion success, symptomatic intracranial hemorrhage, and mortality between EVT patients with and without prior IVT.
Of 5098 patients screened for eligibility, we included 2749 patients, of whom 549 received bridging IVT before EVT. The timing of IVT was not recorded. Witnessed stroke onset and transfer rates were higher in the bridging IVT group (25% versus 12% and 77% versus 55%, respectively, P value for both <0.0001), and time intervals between stroke onset and treatment were shorter (time last known well-start of EVT median 560 minutes [interquartile range, 432-791] versus 724 minutes [interquartile range, 544-912]; P<0.0001). After adjustment for confounders, there was no difference in functional outcome at 3 months (adjusted common odds ratio for modified Rankin Scale shift, 1.03 [95% CI, 0.89-1.19]; P=0.72) or successful reperfusion (adjusted odds ratio, 1.19 [95% CI, 0.81-1.75]; P=0.39). There were no safety concerns associated with bridging IVT versus direct EVT (symptomatic intracranial hemorrhage: adjusted odds ratio, 0.75 [95% CI, 0.38-1.48]; P=0.40; mortality: adjusted odds ratio, 1.14 [95% CI, 0.89-1.46]; P=0.31). Results were unchanged when the analysis was limited to patients who received IVT >6 hours after last known well.
In patients with an anterior circulation large vessel occlusion stroke who underwent EVT 6 to 24 hours from last known well, bridging IVT was not associated with a difference in outcomes compared with direct EVT.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT04096248.
Sujets
PID Serval
serval:BIB_AF0A8C29F35B
PMID
Date de création
2024-05-16T14:05:41.606Z
Date de création dans IRIS
2025-05-21T04:51:53Z