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Bridging Thrombolysis Before Endovascular Therapy in Stroke Patients With Faster Core Growth.
Lin, Longting; Zhang, Hao; Liu, Feifeng; Chen, Chen; Chen, Chushuang; Bivard, Andrew; Parsons, Mark W; Li, Gang.
Afiliação
  • Lin L; From the South Western Clinical School (L.L., M.W.P.), Faculty of Medicine, University of New South Wales, Sydney; Faculty of Health (L.L., Chushuang Chen, M.W.P.), University of Newcastle, Australia; Shanghai East Hospital (H.Z., F.L., Chen Chen, G.L.), Tongji University, China; and Melbourne Brain
  • Zhang H; From the South Western Clinical School (L.L., M.W.P.), Faculty of Medicine, University of New South Wales, Sydney; Faculty of Health (L.L., Chushuang Chen, M.W.P.), University of Newcastle, Australia; Shanghai East Hospital (H.Z., F.L., Chen Chen, G.L.), Tongji University, China; and Melbourne Brain
  • Liu F; From the South Western Clinical School (L.L., M.W.P.), Faculty of Medicine, University of New South Wales, Sydney; Faculty of Health (L.L., Chushuang Chen, M.W.P.), University of Newcastle, Australia; Shanghai East Hospital (H.Z., F.L., Chen Chen, G.L.), Tongji University, China; and Melbourne Brain
  • Chen C; From the South Western Clinical School (L.L., M.W.P.), Faculty of Medicine, University of New South Wales, Sydney; Faculty of Health (L.L., Chushuang Chen, M.W.P.), University of Newcastle, Australia; Shanghai East Hospital (H.Z., F.L., Chen Chen, G.L.), Tongji University, China; and Melbourne Brain
  • Chen C; From the South Western Clinical School (L.L., M.W.P.), Faculty of Medicine, University of New South Wales, Sydney; Faculty of Health (L.L., Chushuang Chen, M.W.P.), University of Newcastle, Australia; Shanghai East Hospital (H.Z., F.L., Chen Chen, G.L.), Tongji University, China; and Melbourne Brain
  • Bivard A; From the South Western Clinical School (L.L., M.W.P.), Faculty of Medicine, University of New South Wales, Sydney; Faculty of Health (L.L., Chushuang Chen, M.W.P.), University of Newcastle, Australia; Shanghai East Hospital (H.Z., F.L., Chen Chen, G.L.), Tongji University, China; and Melbourne Brain
  • Parsons MW; From the South Western Clinical School (L.L., M.W.P.), Faculty of Medicine, University of New South Wales, Sydney; Faculty of Health (L.L., Chushuang Chen, M.W.P.), University of Newcastle, Australia; Shanghai East Hospital (H.Z., F.L., Chen Chen, G.L.), Tongji University, China; and Melbourne Brain
  • Li G; From the South Western Clinical School (L.L., M.W.P.), Faculty of Medicine, University of New South Wales, Sydney; Faculty of Health (L.L., Chushuang Chen, M.W.P.), University of Newcastle, Australia; Shanghai East Hospital (H.Z., F.L., Chen Chen, G.L.), Tongji University, China; and Melbourne Brain
Neurology ; 100(20): e2083-e2092, 2023 05 16.
Article em En | MEDLINE | ID: mdl-36963842
ABSTRACT
BACKGROUND AND

OBJECTIVES:

It is still uncertain that going direct to endovascular thrombectomy (EVT) leads to equivalent outcomes as bridging IV thrombolysis (IVT) in acute ischemic patients. This study aimed to explore whether the rate of ischemic core growth influenced the patient outcomes after bridging IVT vs direct EVT.

METHODS:

This was a retrospective cohort study based on the International Stroke Perfusion Imaging Registry (INSPIRE). It selected acute ischemic stroke patients receiving perfusion CT within 4.5 hours of stroke onset. Patients who went direct to EVT were compared with those who received bridging treatment of IVT before EVT. Ischemic core growth rate was estimated by the acute ischemic core volume on perfusion CT divided by the time from stroke onset to perfusion CT, based on the assumption of a linear growth pattern of ischemic core. Core growth rate was stratified into fast (>15 mL/h) and slow (≤15 mL/h), based on its interaction with bridging IVT in predicting the primary outcome. The primary outcome was modified Rankin scale of 0-2 at 3 months. The secondary outcomes included successful thrombectomy reperfusion defined by modified Thrombolysis in Cerebral Infarction score of 2b-3 and time from groin puncture to reperfusion.

RESULTS:

Of the 1,221 EVT patients in the INSPIRE, 323 patients were selected, of which 82 patients received direct EVT and 241 patients received bridging IVT. Bridging IVT was associated with a higher rate of good clinical outcome among patients with fast core growth (39% vs 7% for direct EVT, odds ratio [OR] 8.75 [1.96-39.1], p = 0.005), but the difference was not notable for patients with slow core growth (55% vs 55% for direct EVT, OR 1.00 [0.53-1.87], p = 0.989). In patients with fast core growth, the bridging and direct EVT patients showed no difference in the reperfusion rate (80% vs 76%, p = 0.616). However, patients who received bridging IVT were more likely to achieve reperfusion earlier (the median groin to reperfusion time of 63.0 vs 94.0 minutes, p = 0.005).

DISCUSSION:

Patients with fast core growth were more likely to benefit from bridging IVT. This is likely because prior IVT facilitates clot removal and thus reduces time to reperfusion.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / Procedimentos Endovasculares / AVC Isquêmico Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Neurology Ano de publicação: 2023 Tipo de documento: Article
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / Procedimentos Endovasculares / AVC Isquêmico Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Humans Idioma: En Revista: Neurology Ano de publicação: 2023 Tipo de documento: Article