Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial.

hemorrhage 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:
13 Apr 2023

Historique:

received: 29 01 2023

accepted: 30 03 2023

entrez: 13 4 2023

pubmed: 14 4 2023

medline: 14 4 2023

Statut: aheadofprint

Résumé

In proximal occlusions, the effect of reperfusion therapies may differ between slow or fast progressors. We investigated the effect of intravenous thrombolysis (IVT) (with alteplase) plus mechanical thrombectomy (MT) versus thrombectomy alone among slow versus fast stroke progressors. The SWIFT-DIRECT trial data were analyzed: 408 patients randomized to IVT+MT or MT alone. Infarct growth speed was defined by the number of points of decay in the initial Alberta Stroke Program Early CT Score (ASPECTS) divided by the onset-to-imaging time. The primary endpoint was 3-month functional independence (modified Rankin scale 0-2). In the primary analysis, the study population was dichotomized into slow and fast progressors using median infarct growth velocity. Secondary analysis was also conducted using quartiles of ASPECTS decay. We included 376 patients: 191 IVT+MT, 185 MT alone; median age 73 years (IQR 65-81); median initial National Institutes of Health Stroke Scale (NIHSS) 17 (IQR 13-20). The median infarct growth velocity was 1.2 points/hour. Overall, we did not observe a significant interaction between the infarct growth speed and the allocation to either randomization group on the odds of favourable outcome (P=0.68). In the IVT+MT group, odds of any intracranial hemorrhage (ICH) were significantly lower in slow progressors (22.8% vs 36.4%; OR 0.52, 95% CI 0.27 to 0.98) and higher among fast progressors (49.4% vs 26.8%; OR 2.62, 95% CI 1.42 to 4.82) (P value for interaction <0.001). Similar results were observed in secondary analyses. In this SWIFT-DIRECT subanalysis, we did not find evidence for a significant interaction of the velocity of infarct growth on the odds of favourable outcome according to treatment by MT alone or combined IVT+MT. However, prior IVT was associated with significantly reduced occurrence of any ICH among slow progressors whereas this was increased in fast progressors.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

The SWIFT-DIRECT trial data were analyzed: 408 patients randomized to IVT+MT or MT alone. Infarct growth speed was defined by the number of points of decay in the initial Alberta Stroke Program Early CT Score (ASPECTS) divided by the onset-to-imaging time. The primary endpoint was 3-month functional independence (modified Rankin scale 0-2). In the primary analysis, the study population was dichotomized into slow and fast progressors using median infarct growth velocity. Secondary analysis was also conducted using quartiles of ASPECTS decay.

RESULTS RESULTS

We included 376 patients: 191 IVT+MT, 185 MT alone; median age 73 years (IQR 65-81); median initial National Institutes of Health Stroke Scale (NIHSS) 17 (IQR 13-20). The median infarct growth velocity was 1.2 points/hour. Overall, we did not observe a significant interaction between the infarct growth speed and the allocation to either randomization group on the odds of favourable outcome (P=0.68). In the IVT+MT group, odds of any intracranial hemorrhage (ICH) were significantly lower in slow progressors (22.8% vs 36.4%; OR 0.52, 95% CI 0.27 to 0.98) and higher among fast progressors (49.4% vs 26.8%; OR 2.62, 95% CI 1.42 to 4.82) (P value for interaction <0.001). Similar results were observed in secondary analyses.

CONCLUSION CONCLUSIONS

In this SWIFT-DIRECT subanalysis, we did not find evidence for a significant interaction of the velocity of infarct growth on the odds of favourable outcome according to treatment by MT alone or combined IVT+MT. However, prior IVT was associated with significantly reduced occurrence of any ICH among slow progressors whereas this was increased in fast progressors.

Identifiants

DOI: 10.1136/jnis-2023-020113 PMID: 37055063

pubmed: 37055063

pii: jnis-2023-020113

doi: 10.1136/jnis-2023-020113

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Investigateurs

Urs Fischer (U)

Johannes Kaesmacher (J)

Daniel Strbian (D)

Omer Eker (O)

Christophe Cognard (C)

Patricia S Plattner (PS)

Lukas Bütikofer (L)

Pasquale Mordasini (P)

Sandro Deppeler (S)

Vitor Mendes-Pereira (V)

Jean François Albucher (JF)

Jean Darcourt (J)

Romain Bourcier (R)

Benoit Guillon (B)

Chrysanthi Papagiannaki (C)

Ozlem Ozkul-Wermester (O)

Gerli Sibolt (G)

Marjaana Tiainen (M)

Benjamin Gory (B)

Sébastien Richard (S)

Jan Liman (J)

Marielle Sophie Ernst (MS)

Marion Boulanger (M)

Charlotte Barbier (C)

Laura Mechtouff (L)

Liqun Zhang (L)

Gaultier Marnat (G)

Igor Sibon (I)

Omid Nikoubashman (O)

Arno Reich (A)

Arturo Consoli (A)

Bertrand Lapergue (B)

Marc Ribo (M)

Alejandro Tomasello (A)

Suzana Saleme (S)

Francisco Macian (F)

Solène Moulin (S)

Paolo Pagano (P)

Guillaume Salliou (G)

Emmanuel Carrera (E)

Kevin Janot (K)

María Hernández-Pérez (M)

Raoul Pop (R)

Lucie Della Schiava (LD)

Andreas R Luft (AR)

Michel Piotin (M)

Jean-Christophe Gentric (JC)

Aleksandra Pikula (A)

Waltraud Pfeilschifter (W)

Marcel Arnold (M)

Adnan H Siddiqui (AH)

Michael T Froehler (MT)

Anthony J Furlan (AJ)

René Chapot (R)

Martin Wiesmann (M)

Paolo Machi (P)

Hans-Christoph Diener (HC)

Zsolt Kulcsar (Z)

Leo Bonati (L)

Claudio L Bassetti (CL)

Mikael Mazighi (M)

David S Liebeskind (DS)

Jeffrey L Saver (JL)

Jan Gralla (J)

Melanie Schmidhalter (M)

Jenny Bressan (J)

Stefanie Lerch (S)

Andreas Limacher (A)

Leonhard von Meyenn (LV)

Martina Zimmermann (M)

Bruce Campbell (B)

Tim Friede (T)

Rüdiger von Kummer (RV)

Angelika Alonso (A)

Caroline Arquizan (C)

Xavier Barreau (X)

Rémy Beaujeux (R)

Daniel Behme (D)

Tobias Boeckh-Behrens (T)

Christian Boehme (C)

Marti Boix (M)

Grégoire Boulouis (G)

Nicolas Bricout (N)

Nicolas Broc (N)

Carlo W Cereda (CW)

Emmanuel Chabert (E)

Tae-Hee Cho (TH)

Alessandro Cianfoni (A)

Vincent Costalat (V)

Christian Denier (C)

Frederico Di Maria (FD)

Richard du Mesnil de Rochemont (RDM)

Patricia Fearon (P)

Anna Ferrier (A)

Sebastian Fischer (S)

Maxime Gauberti (M)

Marie Gaudron (M)

Laetitia Gimenez (L)

Christoph Globas (C)

Michael Görtler (M)

Mayank Goyal (M)

Ruediger Hilker-Roggendorf (R)

Michael D Hill (MD)

Vi Tuan Hua (VT)

Lisa Humbertjean (L)

Olav Jansen (O)

Simon Jung (S)

Georg Kägi (G)

Michael E Kelly (ME)

Ilka Kleffner (I)

Michael Knoflach (M)

Krassen Nedeltchev (K)

Lars Udo Krause (LU)

Kimmo Lappalainen (K)

Margaux Lefebvre (M)

Joe Leyon (J)

Liang Liao (L)

Jean-Sebastien Liegey (JS)

Christian Loehr (C)

Patrik Michel (P)

Stefania Nannoni (S)

Patrick Nicholson (P)

Lorena Nico (L)

Michael Obadia (M)

Julien Ognard (J)

Ayokunle Ogungbemi (A)

Jean-Marc Olivot (JM)

Simon Escalard (S)

Marco Pasi (M)

Lissa Peeling (L)

Jane Perez (J)

Martina Petersen (M)

Eike Piechowiak (E)

Roberto Raposo (R)

Silja Räty (S)

Sarah C Reitz (SC)

Sebastià Remollo (S)

Luca Remonda (L)

Ian Rennie (I)

Manuel Requena (M)

Alexander Riabikin (A)

Roberto Riva (R)

Aymeric Rouchaud (A)

Andrea Rosi (A)

Marta Rubiera (M)

Laurent Spelle (L)

Marlena Schnieder (M)

Joanna D Schaafsma (JD)

Tilman Schubert (T)

Jörg B Schulz (JB)

Mohammed Siddiqui (M)

Sébastien Soize (S)

Michael Sonnberger (M)

Emmanuel Touze (E)

Aude Triquenot (A)

Guillaume Turc (G)

Lucy Vieira (L)

Wagih Ben Hassen (WB)

Judith N Wagner (JN)

Katrin Wasser (K)

Johannes Weber (J)

David Weisenburger-Lile (D)

Fritz Wodarg (F)

Valérie Wolff (V)

Silke Wunderlich (S)

Informations de copyright

Déclaration de conflit d'intérêts

Competing interests: None declared.