Title :

Mechanical thrombectomy outcomes with or without intravenous thrombolysis

Author(s) :

Gariel, Florent [Auteur]
Centre Hospitalier Universitaire de Bordeaux [CHU Bordeaux]
Lapergue, Bertrand [Auteur]
Bourcier, Romain [Auteur]
Berge, Jerome [Auteur]
Barreau, Xavier [Auteur]
Mazighi, Mikael [Auteur]
Kyheng, Maéva [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Labreuche, Julien [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Fahed, Robert [Auteur]
Blanc, Raphael [Auteur]
Gory, Benjamin [Auteur]
Duhamel, Alain [Auteur]
Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS]
Saleme, Suzana [Auteur]
Costalat, Vincent [Auteur]
Bracard, Serge [Auteur]
Desal, Hubert [Auteur]
Detraz, Lili [Auteur]
Consoli, Arturo [Auteur]
Piotin, Michel [Auteur]
Marnat, Gaultier [Auteur]
Département de Neuro-Radiologie [Bordeaux] [DNR - Bordeaux]

Journal title :

Stroke

Abbreviated title :

Stroke

Volume number :

49

Pages :

2383-2390

Publisher :

American Heart Association

Publication date :

2018-09-01

ISSN :

1524-4628

English keyword(s) :

National Institutes of Health (US)
cerebral hemorrhage
anticoagulants
thrombectomy
stroke

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

Background and Purpose- Intravenous thrombolysis (IVT) within 4.5 hours of symptom onset is currently recommended before mechanical thrombectomy (MT). We compared functional outcome, neurological recovery, reperfusion, and ...
Show more >Background and Purpose- Intravenous thrombolysis (IVT) within 4.5 hours of symptom onset is currently recommended before mechanical thrombectomy (MT). We compared functional outcome, neurological recovery, reperfusion, and adverse events according to the use or not of IVT before MT. Methods- This is a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Revascularization). The primary outcome was favorable 90-day functional outcome defined as a modified Rankin Scale of ≤2. Secondary outcomes were successful reperfusion following all procedures and after the first-line procedure, number of device passes, and change in National Institutes of Health Stroke Scale score at 24 hours. Safety outcomes included 90-day mortality and any symptomatic intracerebral hemorrhage. Results- Three hundred eighty-one patients were included, 250 of whom received IVT before MT (IVT+MT group). There were no significant differences between IVT+MT and MT-alone groups in 90-day favorable functional outcome, in successful reperfusion rate (modified Thrombolysis In Cerebral Infarction 2b or 3), in National Institutes of Health Stroke Scale score improvement at 24 hours, or in hemorrhagic complication rate. The 90-day mortality rate in the IVT+MT group was lower than after MT alone (fully-adjusted risk ratio, 0.59; 95% CI, 0.39-0.88). In a subgroup of patients without anticoagulant medication before stroke onset, we observed in the IVT+MT group a better functional outcome (fully-adjusted risk ratio, 1.38; 95% CI, 1.02-1.89), a higher successful recanalization rate after first-line strategy (fully-adjusted risk ratio, 1.26; 95% CI, 1.05-1.50), and a lower mortality rate (fully-adjusted risk ratio, 0.58; 95% CI, 0.36-0.93). Conclusions- Our results show that IVT+MT patients in the ASTER trial have lower 90-day mortality compared with those receiving MT alone. In a selected population of patients without prestroke anticoagulation, we demonstrated that IVT associated with MT might improve functional outcome and recanalization while reducing mortality rates.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Université de Lille

Collections :

• METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694

Submission date :

2019-12-09T18:19:39Z
2024-03-22T07:14:31Z