Influence of prior intravenous thrombolysis in patients treated with mechanical thrombectomy for M2 occlusions: insight from the Endovascular Treatment in Ischemic Stroke (ETIS) registry.
Stroke
Thrombectomy
Thrombolysis
Journal
Journal of neurointerventional surgery
ISSN: 1759-8486
Titre abrégé: J Neurointerv Surg
Pays: England
ID NLM: 101517079
Informations de publication
Date de publication:
Nov 2023
Nov 2023
Historique:
received:
22
09
2022
accepted:
16
11
2022
medline:
6
11
2023
pubmed:
3
12
2022
entrez:
2
12
2022
Statut:
ppublish
Résumé
Intravenous thrombolysis (IVT) for patients treated with mechanical thrombectomy (MT) for proximal occlusions has recently been questioned through randomized trials. However, few patients with M2 occlusions were included. We investigated the influence of prior IVT for patients presenting M2 occlusions treated with MT in comparison with MT alone. We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a multicenter observational study. Data from consecutive patients treated with MT for M2 occlusions between January 2015 and January 2022 at 26 comprehensive stroke centers were analyzed. The primary endpoint was 90-day modified Rankin Scale score of 0-2. Outcomes were compared using propensity score approaches. We also performed sensitivity analysis in relevant subgroups of patients. Among 1132 patients with M2 occlusions treated with MT, 570 received prior IVT. The two groups were comparable after propensity analysis. The rate of favorable functional outcome was significantly higher in the IVT+MT group compared with the MT alone group (59.8% vs 44.7%; adjusted OR 1.38, 95% CI 1.10 to 1.75, P=0.008). Hemorrhagic and procedural complications were similar in both groups. In sensitivity analysis excluding patients with anticoagulation treatment, favorable recanalization was more frequent in the IVT+MT group (OR 1.37, 95% CI 1.11 to 1.70, P=0.004). In cases of M2 occlusions, prior IVT combined with MT resulted in better functional outcome than MT alone, without increasing the rate of hemorrhagic or procedural complications. These results suggest the benefit of IVT in patients undergoing MT for M2 occlusions.
Sections du résumé
BACKGROUND
BACKGROUND
Intravenous thrombolysis (IVT) for patients treated with mechanical thrombectomy (MT) for proximal occlusions has recently been questioned through randomized trials. However, few patients with M2 occlusions were included. We investigated the influence of prior IVT for patients presenting M2 occlusions treated with MT in comparison with MT alone.
METHODS
METHODS
We conducted a retrospective analysis of the Endovascular Treatment in Ischemic Stroke (ETIS) registry, a multicenter observational study. Data from consecutive patients treated with MT for M2 occlusions between January 2015 and January 2022 at 26 comprehensive stroke centers were analyzed. The primary endpoint was 90-day modified Rankin Scale score of 0-2. Outcomes were compared using propensity score approaches. We also performed sensitivity analysis in relevant subgroups of patients.
RESULTS
RESULTS
Among 1132 patients with M2 occlusions treated with MT, 570 received prior IVT. The two groups were comparable after propensity analysis. The rate of favorable functional outcome was significantly higher in the IVT+MT group compared with the MT alone group (59.8% vs 44.7%; adjusted OR 1.38, 95% CI 1.10 to 1.75, P=0.008). Hemorrhagic and procedural complications were similar in both groups. In sensitivity analysis excluding patients with anticoagulation treatment, favorable recanalization was more frequent in the IVT+MT group (OR 1.37, 95% CI 1.11 to 1.70, P=0.004).
CONCLUSIONS
CONCLUSIONS
In cases of M2 occlusions, prior IVT combined with MT resulted in better functional outcome than MT alone, without increasing the rate of hemorrhagic or procedural complications. These results suggest the benefit of IVT in patients undergoing MT for M2 occlusions.
Identifiants
pubmed: 36460462
pii: jnis-2022-019672
doi: 10.1136/jnis-2022-019672
doi:
Substances chimiques
Fibrinolytic Agents
0
Types de publication
Multicenter Study
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e289-e297Investigateurs
Bertrand Lapergue
(B)
Adrien Wang
(A)
Arturo Consoli
(A)
Oguzhan Coskun
(O)
Federico Di Maria
(FD)
Silvia Pizzuto
(S)
Alessandro Sgreccia
(A)
Charline Benoit
(C)
Lucas Gorza
(L)
David Weisenburger-Lile
(D)
Waliyde Jabeur
(W)
Tchikviladze Maia
(T)
Serge Evrard
(S)
Georges Rodesch
(G)
Raphaël Blanc
(R)
Jean-Philippe Desilles
(JP)
Michel Piotin
(M)
Stanislas Smajda
(S)
Simon Escalard
(S)
Benjamin Maier
(B)
Hocine Redjem
(H)
Mikael Mazhigi
(M)
François Delvoye
(F)
Amira Al Raaisi
(AA)
William Boisseau
(W)
Omer Eker
(O)
Tae-Hee Cho
(TH)
Laurent Derex
(L)
Julia Fontaine
(J)
Laura Mechtouff
(L)
Norbert Nighoghossian
(N)
Elodie Ong
(E)
Lucie Rascle
(L)
Roberto Riva
(R)
Françis Turjman
(F)
Morgane Laubacher
(M)
Mehdi Beyragued
(M)
Yves Berthezene
(Y)
Marc Hermier
(M)
Ameli Roxanna
(A)
Alexandre Bani-Sadr
(A)
Andrea Filip
(A)
Matteo Cappucci
(M)
Romain Bourcier
(R)
Benjamin Daumas Duport
(BD)
Pierre Louis Alexandre
(PL)
Cédric Lenoble
(C)
Hubert Desal
(H)
Solene De Gaalon
(S)
Benoît Guillon
(B)
Cécile Preterre
(C)
Guillaume Tessier
(G)
Arthur Lionnet
(A)
Benjamin Gory
(B)
Lisa Humbertjean-Selton
(L)
René Anxionnat
(R)
Anne-Laure Derelle
(AL)
Liang Liao
(L)
Emmanuelle Schmitt
(E)
Sophie Planel
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Sébastien Richard
(S)
Gioia Mione
(G)
Jean-Christophe Lacour
(JC)
Marian Douarinou
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Emilien Micard
(E)
Bailiang Chen
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Gérard Audibert
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Agnès Masson
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Lionel Alb
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Marine Beaumont
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Adriana Tabarna
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Marcela Voicu
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Grégoire Barthel
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Iona Podar
(I)
Madalina Brezeanu
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Marie Reitter
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François Zhu
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Gaultier Marnat
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Jean-Sébastien Liegey
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Pierre Briau
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Jérome Berge
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Sabrina Debruxelles
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Stephane Olindo
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Mathilde Poli
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Pauline Renou
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Sharmila Sagnier
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Thomas Tourdias
(T)
Thomas Courret
(T)
Ludovic Lucas
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Malgorzata Milnerowicz
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Cyril Dargazanli
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Vincent Costalat
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Isabelle Mourand
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Caroline Arquizan
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Lucas Corti
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Adrien Ter Schiphorst
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Imad Derraz
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Informations de copyright
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.