Association of intravenous thrombolysis and pre-interventional reperfusion: a post hoc analysis of the SWIFT DIRECT trial.

Mujanovic, Adnan; Eker, Omer; Marnat, Gaultier; Strbian, Daniel; Ijäs, Petra; Préterre, Cécile; Triquenot, Aude; Albucher, Jean François; Gauberti, Maxime; Weisenburger-Lile, David; Ernst, Marielle; Nikoubashman, Omid; Mpotsaris, Anastasios; Gory, Benjamin; Tuan Hua, Vi; Ribo, Marc; Liebeskind, David S; Dobrocky, Tomas; Meinel, Thomas R; Buetikofer, Lukas; ... (2023). Association of intravenous thrombolysis and pre-interventional reperfusion: a post hoc analysis of the SWIFT DIRECT trial. Journal of neurointerventional surgery, 15(e2), e232-e239. BMJ Publishing Group 10.1136/jnis-2022-019585

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A potential benefit of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) is pre-interventional reperfusion. Currently, there are few data on the occurrence of pre-interventional reperfusion in patients randomized to IVT or no IVT before MT.


SWIFT DIRECT (Solitaire With the Intention For Thrombectomy Plus Intravenous t-PA vs DIRECT Solitaire Stent-retriever Thrombectomy in Acute Anterior Circulation Stroke) was a randomized controlled trial including acute ischemic stroke IVT eligible patients being directly admitted to a comprehensive stroke center, with allocation to IVT with MT versus MT alone. The primary endpoint of this analysis was the occurrence of pre-interventional reperfusion, defined as a pre-interventional expanded Thrombolysis in Cerebral Infarction score of ≥2a. The effect of IVT and potential treatment effect heterogeneity were analyzed using logistic regression analyses.


Of 396 patients, pre-interventional reperfusion occurred in 20 (10.0%) patients randomized to IVT with MT, and in 7 (3.6%) patients randomized to MT alone. Receiving IVT favored the occurrence of pre-interventional reperfusion (adjusted OR 2.91, 95% CI 1.23 to 6.87). There was no IVT treatment effect heterogeneity on the occurrence of pre-interventional reperfusion with different strata of Randomization-to-Groin-Puncture time (p for interaction=0.33), although the effect tended to be stronger in patients with a Randomization-to-Groin-Puncture time >28 min (adjusted OR 4.65, 95% CI 1.16 to 18.68). There were no significant differences in rates of functional outcomes between patients with and without pre-interventional reperfusion.


Even for patients with proximal large vessel occlusions and direct access to MT, IVT resulted in an absolute increase of 6% in rates of pre-interventional reperfusion. The influence of time strata on the occurrence of pre-interventional reperfusion should be studied further in an individual patient data meta-analysis of comparable trials.


Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Department of Clinical Research (DCR)
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

UniBE Contributor:

Dobrocky, Tomas, Meinel, Thomas Raphael, Bütikofer, Lukas (B), Gralla, Jan, Fischer, Urs Martin, Kaesmacher, Johannes


600 Technology > 610 Medicine & health




BMJ Publishing Group




Pubmed Import

Date Deposited:

21 Nov 2022 15:46

Last Modified:

20 Feb 2024 14:15

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Stroke Thrombectomy Thrombolysis




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