Title :

In a hub-and-spoke network, spoke-administered thrombolysis reduces mechanical thrombectomy procedure time and number of passes

Author(s) :

Kraft, A. W. [Auteur]
Awad, A. [Auteur]
Rosenthal, J. A. [Auteur]
Dmytriw, A. A. [Auteur]
Vranic, J. E. [Auteur]
Bonkhoff, A. K. [Auteur]
Bretzner, Martin [Auteur]
Lille Neurosciences & Cognition - U 1172 [LilNCog]
Hirsch, J. A. [Auteur]
Rabinov, J. D. [Auteur]
Stapleton, C. J. [Auteur]
Schwamm, L. H. [Auteur]
Rost, N. S. [Auteur]
Leslie-Mazwi, T. M. [Auteur]
Patel, A. B. [Auteur]
Regenhardt, R. W. [Auteur]

Journal title :

Interventional Neuroradiology

Volume number :

29

Pages :

-

Publication date :

2023-05-30

ISSN :

1591-0199

Keyword(s) :

Large vessel occlusion
mechanical thrombectomy
tissue plasminogen activator
endovascular therapy
ischemic stroke

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Background The utility of intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT) in large vessel occlusion stroke (LVO) is controversial. Some data suggest IVT increases MT technical difficulty. Within our ...
Show more >Background The utility of intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MT) in large vessel occlusion stroke (LVO) is controversial. Some data suggest IVT increases MT technical difficulty. Within our hub-and-spoke telestroke network, we examined how spoke-administered IVT affected hub MT procedure time and pass number. Methods Patients presenting to 25 spoke hospitals who were transferred to the hub and underwent MT from 2018 to 2020 were identified from a prospectively maintained database. MT procedure time, fluoroscopy time, and pass number were obtained from operative reports. Results Of 107 patients, 48 received IVT at spokes. Baseline characteristics and NIHSS were similar. The last known well (LKW)-to-puncture time was shorter among IVT patients (4.3 ± 1.9 h vs. 10.5 ± 6.5 h, p < 0.0001). In patients that received IVT, mean MT procedure time was decreased by 18.8 min (50.5 ± 29.4 vs. 69.3 ± 46.7 min, p = 0.02) and mean fluoroscopy time was decreased by 11.3 min (21.7 ± 15.8 vs. 33.0 ± 30.9 min, p = 0.03). Furthermore, IVT-treated patients required fewer MT passes (median 1 pass [IQR 1.0, 1.80] vs. 2 passes [1.0, 2.3], p = 0.0002) and were more likely to achieve reperfusion in ≤2 passes (81.3% vs. 59.3%, p = 0.01). An increased proportion of IVT-treated patients achieved TICI 2b-3 reperfusion after MT (93.9% vs. 83.8%, p = 0.045). There were no associations between MT procedural characteristics and LKW-to-puncture time. Conclusion Within our network, hub MT following spoke-administered IVT was faster, required fewer passes, and achieved improved reperfusion. This suggests spoke-administered IVT does not impair MT, but instead may enhance it.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
Inserm
CHU Lille

Collections :

• Lille Neurosciences & Cognition (LilNCog) - U 1172

Submission date :

2024-01-16T01:24:08Z
2025-01-09T08:41:51Z