Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry.

Kaesmacher, Johannes; Abdullayev, Nuran; Maamari, Basel; Dobrocky, Tomas; Vynckier, Jan; Piechowiak, Eike I.; Pop, Raoul; Behme, Daniel; Sporns, Peter B; Styczen, Hanna; Virtanen, Pekka; Meyer, Lukas; Meinel, Thomas R.; Cantré, Daniel; Kabbasch, Christoph; Maus, Volker; Pekkola, Johanna; Fischer, Sebastian; Hasiu, Anca; Schwarz, Alexander; ... (2021). Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry. Journal of stroke, 23(1), pp. 91-102. Korean Stroke Society 10.5853/jos.2020.01788

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BACKGROUND AND PURPOSE

Data on safety and efficacy of intra-arterial (IA) fibrinolytics as adjunct to mechanical thrombectomy (MT) are sparse.

METHODS

INtra-arterial FIbriNolytics In ThrombectomY (INFINITY) is a retrospective multi-center observational registry of consecutive patients with anterior circulation large-vessel occlusion ischemic stroke treated with MT and adjunctive administration of IA fibrinolytics (alteplase [tissue plasminogen activator, tPA] or urokinase [UK]) at 10 European centers. Primary outcome was the occurrence of symptomatic intracranial hemorrhage (sICH) according to the European Cooperative Acute Stroke Study II definition. Secondary outcomes were mortality and modified Rankin Scale (mRS) scores at 3 months.

RESULTS

Of 5,612 patients screened, 311 (median age, 74 years; 44.1% female) received additional IA after or during MT (194 MT+IA tPA, 117 MT+IA UK). IA fibrinolytics were mostly administered for rescue of thrombolysis in cerebral infarction (TICI) 0-2b after MT (80.4%, 250/311). sICH occurred in 27 of 308 patients (8.8%), with an increased risk in patients with initial TICI0/1 (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1 to 5.0 per TICI grade decrease) or in those with intracranial internal carotid artery occlusions (aOR, 3.7; 95% CI, 1.2 to 12.5). In patients with attempted rescue of TICI0-2b and available angiographic follow-up, 116 of 228 patients (50.9%) showed any angiographic reperfusion improvement after IA fibrinolytics, which was associated with mRS ≤2 (aOR, 3.1; 95% CI, 1.4 to 6.9).

CONCLUSIONS

Administration of IA fibrinolytics as adjunct to MT is performed rarely, but can improve reperfusion, which is associated with better outcomes. Despite a selection bias, an increased risk of sICH seems possible, which underlines the importance of careful patient selection.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic, Interventional and Paediatric Radiology

UniBE Contributor:

Kaesmacher, Johannes; Maamari, Basel; Dobrocky, Tomas; Vynckier, Jan Luc; Piechowiak, Eike Immo; Meinel, Thomas Raphael; Seiffge, David Julian; Mordasini, Pasquale; Gralla, Jan and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2287-6405

Publisher:

Korean Stroke Society

Language:

English

Submitter:

Maria de Fatima Henriques Bernardo

Date Deposited:

20 Apr 2021 10:32

Last Modified:

20 Apr 2021 10:32

Publisher DOI:

10.5853/jos.2020.01788

PubMed ID:

33600706

Uncontrolled Keywords:

Intracranial hemorrhages Stroke Thrombectomy Thrombolytic therapy Tissue plasminogen activator

BORIS DOI:

10.7892/boris.152801

URI:

https://boris.unibe.ch/id/eprint/152801

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