Association of Intravenous Thrombolysis with Delayed Reperfusion After Incomplete Mechanical Thrombectomy.

Mujanovic, Adnan; Kammer, Christoph; Kurmann, Christoph C; Grunder, Lorenz; Beyeler, Morin; Lang, Matthias F; Piechowiak, Eike I; Meinel, Thomas R; Jung, Simon; Almiri, William; Pilgram-Pastor, Sara; Hoffmann, Angelika; Seiffge, David J; Heldner, Mirjam R; Dobrocky, Tomas; Mordasini, Pasquale; Arnold, Marcel; Gralla, Jan; Fischer, Urs and Kaesmacher, Johannes (2022). Association of Intravenous Thrombolysis with Delayed Reperfusion After Incomplete Mechanical Thrombectomy. (In Press). Clinical neuroradiology Springer-Verlag 10.1007/s00062-022-01186-7

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PURPOSE

Treatment of distal vessel occlusions causing incomplete reperfusion after mechanical thrombectomy (MT) is debated. We hypothesized that pretreatment with intravenous thrombolysis (IVT) may facilitate delayed reperfusion (DR) of residual vessel occlusions causing incomplete reperfusion after MT.

METHODS

Retrospective analysis of patients with incomplete reperfusion after MT, defined as extended thrombolysis in cerebral infarction (eTICI) 2a-2c, and available perfusion follow-up imaging at 24 ± 12 h after MT. DR was defined as absence of any perfusion deficit on time-sensitive perfusion maps, indicating the absence of any residual occlusion. The association of IVT with the occurrence of DR was evaluated using a logistic regression analysis adjusted for confounders. Sensitivity analyses based on IVT timing (time between IVT start and the occurrence incomplete reperfusion following MT) were performed.

RESULTS

In 368 included patients (median age 73.7 years, 51.1% female), DR occurred in 225 (61.1%). Atrial fibrillation, higher eTICI grade, better collateral status and longer intervention-to-follow-up time were all associated with DR. IVT did not show an association with the occurrence of DR (aOR 0.80, 95% CI 0.44-1.46, even in time-sensitive strata, aOR 2.28 [95% CI 0.65-9.23] and aOR 1.53 [95% CI 0.52-4.73] for IVT to incomplete reperfusion following MT timing <80 and <100 min, respectively).

CONCLUSION

A DR occurred in 60% of patients with incomplete MT at ~24 h and did not seem to occur more often in patients receiving pretreatment IVT. Further research on potential associations of IVT and DR after MT is required.

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:

Mujanovic, Adnan; Kurmann, Christoph Carmelino; Grunder, Lorenz Nicolas; Beyeler, Morin; Lang, Matthias; Piechowiak, Eike Immo; Meinel, Thomas Raphael; Jung, Simon; Almiri, William; Pilgram-Pastor, Sara Magdalena; Hoffmann, Angelika; Seiffge, David Julian; Heldner, Mirjam Rachel; Dobrocky, Tomas; Mordasini, Pasquale; Arnold, Marcel; Gralla, Jan; Fischer, Urs and Kaesmacher, Johannes

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1869-1439

Publisher:

Springer-Verlag

Language:

English

Submitter:

Pubmed Import

Date Deposited:

19 Jul 2022 13:44

Last Modified:

21 Jul 2022 06:17

Publisher DOI:

10.1007/s00062-022-01186-7

PubMed ID:

35833948

Uncontrolled Keywords:

Incomplete Reperfusion Ischemic stroke Outcome Perfusion imaging Tissue-type plasminogen activator tPA

BORIS DOI:

10.48350/171325

URI:

https://boris.unibe.ch/id/eprint/171325

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