Intravenous Thrombolysis Is Not Associated with Increased Time to Endovascular Treatment.
Administration, Intravenous
Aged
Aged, 80 and over
Brain Ischemia
/ diagnostic imaging
Endovascular Procedures
/ adverse effects
Female
Fibrinolytic Agents
/ administration & dosage
Humans
Intracranial Hemorrhages
/ etiology
Male
Middle Aged
Netherlands
Registries
Retrospective Studies
Risk Assessment
Risk Factors
Stroke
/ diagnostic imaging
Thrombolytic Therapy
/ adverse effects
Time Factors
Time-to-Treatment
Treatment Outcome
Workflow
Acute stroke intervention
Endovascular treatment of acute stroke
Intravenous thrombolytic therapy of stroke
Stroke organization
Workflow
Journal
Cerebrovascular diseases (Basel, Switzerland)
ISSN: 1421-9786
Titre abrégé: Cerebrovasc Dis
Pays: Switzerland
ID NLM: 9100851
Informations de publication
Date de publication:
2020
2020
Historique:
received:
02
03
2020
accepted:
24
05
2020
pubmed:
3
7
2020
medline:
1
12
2020
entrez:
3
7
2020
Statut:
ppublish
Résumé
Endovascular treatment (EVT) with or without intravenous thrombolysis (IVT) is effective and safe in is-chemic stroke caused by large vessel occlusion, but IVT might delay time to EVT or increase risk of intracranial hemorrhage (ICH). We assessed the influence of prior IVT on time to treatment and risk of ICH in patients treated with EVT. We analyzed data from the MR CLEAN Registry and included patients with an anterior circulation occlusion treated with EVT who presented directly to an intervention center, between 2014 and 2017. Primary endpoint was the door to groin time. Secondary outcomes were workflow time intervals and safety outcomes. We compared patients who received EVT only with patients who received IVT prior to EVT. We included 1,427 patients directly referred to an intervention center of whom 1,023 (72%) received IVT + EVT. Adjusted door to CT imaging and door to groin time were shorter in IVT + EVT patients (difference 5.7 min [95% CI: 4.6-6.8] and 7.0 min [95% CI: 2.4-12], respectively) while CT imaging to groin time was similar between the groups. Early recanalization on digital subtraction angiography before EVT was seen more often after prior IVT (11 vs. 5.2%, aOR 2.4 [95% CI: 1.4-4.2]). Rates of symptomatic ICH were similar. Prior IVT did not delay door to groin times and was associated with higher rates of early recanalization, without increasing the risk of ICH. Our results do not warrant withholding IVT prior to EVT.
Sections du résumé
BACKGROUND
Endovascular treatment (EVT) with or without intravenous thrombolysis (IVT) is effective and safe in is-chemic stroke caused by large vessel occlusion, but IVT might delay time to EVT or increase risk of intracranial hemorrhage (ICH). We assessed the influence of prior IVT on time to treatment and risk of ICH in patients treated with EVT.
METHODS
We analyzed data from the MR CLEAN Registry and included patients with an anterior circulation occlusion treated with EVT who presented directly to an intervention center, between 2014 and 2017. Primary endpoint was the door to groin time. Secondary outcomes were workflow time intervals and safety outcomes. We compared patients who received EVT only with patients who received IVT prior to EVT.
RESULTS
We included 1,427 patients directly referred to an intervention center of whom 1,023 (72%) received IVT + EVT. Adjusted door to CT imaging and door to groin time were shorter in IVT + EVT patients (difference 5.7 min [95% CI: 4.6-6.8] and 7.0 min [95% CI: 2.4-12], respectively) while CT imaging to groin time was similar between the groups. Early recanalization on digital subtraction angiography before EVT was seen more often after prior IVT (11 vs. 5.2%, aOR 2.4 [95% CI: 1.4-4.2]). Rates of symptomatic ICH were similar.
CONCLUSION
Prior IVT did not delay door to groin times and was associated with higher rates of early recanalization, without increasing the risk of ICH. Our results do not warrant withholding IVT prior to EVT.
Identifiants
pubmed: 32615562
pii: 000508898
doi: 10.1159/000508898
doi:
Substances chimiques
Fibrinolytic Agents
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
321-327Informations de copyright
© 2020 The Author(s) Published by S. Karger AG, Basel.