Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy

Kaesmacher, Johannes; Peschi, Giovanni; Abdullayev, Nuran; Maamari, Basel; Dobrocky, Tomas; Vynckier, Jan Luc; Piechowiak, Eike; 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; ... (2021). Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy. Clinical and translational neuroscience, 5(1), pp. 1-7. Sage Publications 10.1177/2514183X211017363

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Objective:
To identify factors associated with early angiographic reperfusion improvement (EARI) following intra-arterial fibrinolytics (IAF) after failed or incomplete mechanical thrombectomy (MT).

Methods:
A subset of patients treated with MT and IAF rescue after incomplete reperfusion included in the INFINITY (INtra-arterial FIbriNolytics In ThrombectomY) multicenter observational registry was analyzed. Multivariable logistic regression was used to identify factors associated with EARI. Heterogeneity of the clinical effect of EARI on functional independence (defined as modified Rankin Score ≤2) was tested with interaction terms.

Results:
A total of 228 patients (median age: 72 years, 44.1% female) received IAF as rescue for failed or incomplete MT and had a post-fibrinolytic angiographic control run available (50.9% EARI). A cardioembolic stroke origin (adjusted odds ratio (aOR) 3.72, 95% confidence interval (CI) 1.39–10.0) and shorter groin puncture to IAF intervals (aOR 0.82, 95% CI 0.71–0.95 per 15-min delay) were associated with EARI, while pre-interventional thrombolysis showed no association (aOR 1.15, 95% CI 0.59–2.26). The clinical benefit of EARI after IAF seemed more pronounced in patients without or only minor early ischemic changes (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥9, aOR 4.00, 95% CI 1.37–11.61) and was absent in patients with moderate to severe ischemic changes (ASPECTS ≤8, aOR 0.94, 95% CI 0.27–3.27, p for interaction: 0.095).

Conclusion:
Early rescue and a cardioembolic stroke origin were associated with more frequent EARI after IAF. The clinical effect of EARI seemed reduced in patients with already established infarcts. If confirmed, these findings can help to inform patient selection and inclusion criteria for randomized-controlled trials evaluating IAF as rescue after MT.

Item Type:

Journal Article (Original Article)

Division/Institute:

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

UniBE Contributor:

Kaesmacher, Johannes; Peschi, Giovanni; 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:

2514-183X

Publisher:

Sage Publications

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

30 Nov 2021 09:41

Last Modified:

30 Nov 2021 09:41

Publisher DOI:

10.1177/2514183X211017363

BORIS DOI:

10.48350/161308

URI:

https://boris.unibe.ch/id/eprint/161308

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