Mujanovic, Adnan; Dobrocky, Tomas; Pfeilschifter, Waltraud; Remonda, Luca; Caroff, Jildaz; Behme, Daniel; Seiffge, David J; Cereda, Carlo W; Kägi, Georg; Leyon, Joe; Piechowiak, Eike I; Costalat, Vincent; Wagner, Judith; Chabert, Emmanuel; Meinel, Thomas R; Jansen, Olav; Alonso, Angelika; Loehr, Christian; Liebeskind, David S; Gralla, Jan; ... (2024). Value of intravenous alteplase before thrombectomy among patients with tandem lesions and emergent carotid artery stenting: A subgroup analysis of the SWIFT DIRECT trial. European journal of neurology, 31(6), e16256. Wiley 10.1111/ene.16256
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Euro_J_of_Neurology_-_2024_-_Mujanovic_-_Value_of_intravenous_alteplase_before_thrombectomy_among_patients_with_tandem.pdf - Published Version Available under License Creative Commons: Attribution (CC-BY). Download (1MB) | Preview |
BACKGROUND AND PURPOSE
The value of intravenous thrombolysis (IVT) in eligible tandem lesion patients undergoing endovascular treatment (EVT) is unknown. We investigated treatment effect heterogeneity of EVT + IVT versus EVT-only in tandem lesion patients. Additional analyses were performed for patients undergoing emergent internal carotid artery (ICA) stenting.
METHODS
SWIFT DIRECT randomized IVT-eligible patients to either EVT + IVT or EVT-only. Primary outcome was 90-day functional independence (modified Rankin Scale score 0-2) after the index event. Secondary endpoints were reperfusion success, 24 h intracranial hemorrhage rate, and 90-day all-cause mortality. Interaction models were fitted for all predefined outcomes.
RESULTS
Among 408 included patients, 63 (15.4%) had a tandem lesion and 33 (52.4%) received IVT. In patients with tandem lesions, 20 had undergone emergent ICA stenting (EVT + IVT: 9/33, 27.3%; EVT: 11/30, 36.7%). Tandem lesion did not show treatment effect modification of IVT on rates of functional independence (tandem lesion EVT + IVT vs. EVT: 63.6% vs. 46.7%, non-tandem lesion EVT + IVT vs. EVT: 65.6% vs. 58.2%; p for interaction = 0.77). IVT also did not increase the risk of intracranial hemorrhage among tandem lesion patients (tandem lesion EVT + IVT vs. EVT: 34.4% vs. 46.7%, non-tandem lesion EVT + IVT vs. EVT: 33.5% vs. 26.3%; p for interaction = 0.15). No heterogeneity was noted for other endpoints (p for interaction > 0.05).
CONCLUSIONS
No treatment effect heterogeneity of EVT + IVT versus EVT-only was observed among tandem lesion patients. Administering IVT in patients with anticipated emergent ICA stenting seems safe, and the latter should not be a factor to consider when deciding to administer IVT before EVT.
Item Type: |
Journal Article (Original Article) |
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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 |
UniBE Contributor: |
Mujanović, Adnan, Dobrocky, Tomas, Seiffge, David Julian, Piechowiak, Eike Immo, Meinel, Thomas Raphael, Gralla, Jan, Fischer, Urs Martin, Kaesmacher, Johannes |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1468-1331 |
Publisher: |
Wiley |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
28 Feb 2024 13:49 |
Last Modified: |
09 May 2024 00:14 |
Publisher DOI: |
10.1111/ene.16256 |
PubMed ID: |
38409874 |
Uncontrolled Keywords: |
extracranial stent intravenous thrombolysis mechanical thrombectomy randomized controlled trial tandem lesion |
BORIS DOI: |
10.48350/193491 |
URI: |
https://boris.unibe.ch/id/eprint/193491 |
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