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Intra-Arterial Thrombolysis is Associated with Delayed Reperfusion of Remaining Vessel Occlusions following Incomplete Thrombectomy.
Mujanovic, A; Kurmann, C C; Serrallach, B L; Dobrocky, T; Meinel, T R; Windecker, D; Grunder, L; Beyeler, M; Seiffge, D J; Pilgram-Pastor, S; Arnold, M; Piechowiak, E I; Gralla, J; Fischer, U; Kaesmacher, J.
Afiliação
  • Mujanovic A; From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Kurmann CC; From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Serrallach BL; Department of Diagnostic, Interventional and Pediatric Radiology (C.C.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Dobrocky T; From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Meinel TR; From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Windecker D; Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Grunder L; From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Beyeler M; From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Seiffge DJ; Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Pilgram-Pastor S; Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Arnold M; From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Piechowiak EI; Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Gralla J; From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Fischer U; From the Department of Diagnostic and Interventional Neuroradiology (A.M., C.C.K., B.L.S., T.D., D.W., L.G., S.P.-P., E.I.P., J.G., J.K.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
  • Kaesmacher J; Department of Neurology (T.R.M., M.B., D.J.S., M.A., U.F.), University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland.
AJNR Am J Neuroradiol ; 44(9): 1050-1056, 2023 09.
Article em En | MEDLINE | ID: mdl-37500281
ABSTRACT
BACKGROUND AND

PURPOSE:

Intra-arterial thrombolytics may be used to treat distal vessel occlusions, which cause incomplete reperfusion following mechanical thrombectomy. Because immediate reperfusion after intra-arterial thrombolytics occurs rarely, the aim of this study was to assess the delayed effect of intra-arterial thrombolytics using follow-up perfusion imaging. MATERIALS AND

METHODS:

We included patients from a prospective stroke registry (February 2015 to September 2022) who had undergone mechanical thrombectomy and had incomplete reperfusion (expanded TICI 2a-2c) and available 24 hour perfusion imaging. Perfusion imaging was rated as delayed reperfusion if time-sensitive perfusion maps did not show wedge-shaped delays suggestive of persisting occlusions corresponding to the post-mechanical thrombectomy angiographic deficit. Patients treated with intra-arterial thrombolytics were compared with controls using multivariable logistic regression and inverse probability of treatment weighting matching for baseline differences and factors associated with delayed reperfusion.

RESULTS:

The median age of the final study population (n = 459) was 74 years (interquartile range, 63-81 years), and delayed reperfusion occurred in 61% of cases. Patients treated with additional intra-arterial thrombolytics (n = 40) were younger and had worse expanded TICI scores. After matching was performed, intra-arterial thrombolytics was associated with higher rates of delayed reperfusion (adjusted OR = 2.7; 95% CI, 1.1-6.4) and lower rates of new infarction in the residually hypoperfused territory after mechanical thrombectomy (adjusted OR = 0.3; 95% CI, 0.1-0.7). No difference was found in the rates of functional independence (90-day mRS, 0-2; adjusted OR = 1.4; 95% CI, 0.4-4.1).

CONCLUSIONS:

Rescue intra-arterial thrombolytics is associated with delayed reperfusion of remaining vessel occlusions following incomplete mechanical thrombectomy. The value of intra-arterial thrombolytics as a potential therapy for incomplete reperfusions after mechanical thrombectomy should be assessed in the setting of randomized controlled trials.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral Tipo de estudo: Clinical_trials / Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Humans / Middle aged Idioma: En Revista: AJNR Am J Neuroradiol Ano de publicação: 2023 Tipo de documento: Article
Texto completo
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral Tipo de estudo: Clinical_trials / Observational_studies / Risk_factors_studies Limite: Aged / Aged80 / Humans / Middle aged Idioma: En Revista: AJNR Am J Neuroradiol Ano de publicação: 2023 Tipo de documento: Article