Titre :

Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial.

Auteur(s) :

Marnat, G. [Auteur]
Centre Hospitalier Universitaire de Bordeaux [CHU Bordeaux]
Kaesmacher, J. [Auteur]
Buetikofer, L. [Auteur]
Sibon, I. [Auteur]
Saleme, S. [Auteur]
Pop, R. [Auteur]
Henon, Hilde [Auteur]
Lille Neurosciences & Cognition (LilNCog) - U 1172
Michel, P. [Auteur]
Mazighi, M. [Auteur]
Kulcsar, Z. [Auteur]
Janot, K. [Auteur]
Machi, P. [Auteur]
Pikula, A. [Auteur]
Gentric, J. C. [Auteur]
Hernández-Pérez, M. [Auteur]
Krause, L. U. [Auteur]
Turc, G. [Auteur]
Liebeskind, D. S. [Auteur]
Gralla, J. [Auteur]
Fischer, U. [Auteur]

Titre de la revue :

Journal of Neurointerventional Surgery

Nom court de la revue :

J Neurointerv Surg

Numéro :

16

Éditeur :

BMJ

Date de publication :

2023-04-13

ISSN :

1759-8486

Mot(s)-clé(s) :

stroke
thrombectomy
thrombolysis
hemorrhage

Mot(s)-clé(s) en anglais :

hemorrhage
thrombolysis
thrombectomy
stroke

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

Background In proximal occlusions, the effect of reperfusion therapies may differ between slow or fast progressors. We investigated the effect of intravenous thrombolysis (IVT) (with alteplase) plus mechanical thrombectomy ...
Lire la suite >Background In proximal occlusions, the effect of reperfusion therapies may differ between slow or fast progressors. We investigated the effect of intravenous thrombolysis (IVT) (with alteplase) plus mechanical thrombectomy (MT) versus thrombectomy alone among slow versus fast stroke progressors. Methods The SWIFT-DIRECT trial data were analyzed: 408 patients randomized to IVT+MT or MT alone. Infarct growth speed was defined by the number of points of decay in the initial Alberta Stroke Program Early CT Score (ASPECTS) divided by the onset-to-imaging time. The primary endpoint was 3-month functional independence (modified Rankin scale 0–2). In the primary analysis, the study population was dichotomized into slow and fast progressors using median infarct growth velocity. Secondary analysis was also conducted using quartiles of ASPECTS decay. Results We included 376 patients: 191 IVT+MT, 185 MT alone; median age 73 years (IQR 65–81); median initial National Institutes of Health Stroke Scale (NIHSS) 17 (IQR 13–20). The median infarct growth velocity was 1.2 points/hour. Overall, we did not observe a significant interaction between the infarct growth speed and the allocation to either randomization group on the odds of favourable outcome (P=0.68). In the IVT+MT group, odds of any intracranial hemorrhage (ICH) were significantly lower in slow progressors (22.8% vs 36.4%; OR 0.52, 95% CI 0.27 to 0.98) and higher among fast progressors (49.4% vs 26.8%; OR 2.62, 95% CI 1.42 to 4.82) (P value for interaction <0.001). Similar results were observed in secondary analyses. Conclusion In this SWIFT-DIRECT subanalysis, we did not find evidence for a significant interaction of the velocity of infarct growth on the odds of favourable outcome according to treatment by MT alone or combined IVT+MT. However, prior IVT was associated with significantly reduced occurrence of any ICH among slow progressors whereas this was increased in fast progressors.Lire moins >

Langue :

Anglais

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

Université de Lille
Inserm
CHU Lille

Collections :

• Lille Neurosciences & Cognition (LilNCog) - U 1172

Date de dépôt :

2024-01-15T23:07:06Z
2025-02-12T09:28:19Z