The role of intravenous thrombolysis before mechanical Thrombectomy: A subgroup analysis of the RESILIENT trial.
J Neurol Sci
; 457: 122853, 2024 Feb 15.
Article
in En
| MEDLINE
| ID: mdl-38182456
ABSTRACT
BACKGROUND:
Randomized trials have recently evaluated the non-inferiority of direct thrombectomy versus intravenous thrombolysis (IVT) followed by endovascular therapy in anterior circulation large vessel occlusion (LVO) stroke in patients eligible for IVT within 4.5 h from stroke onset with controversial results. We aimed to assess the effect of IVT on the clinical outcome of mechanical thrombectomy (MT) in the RESILIENT trial.METHODS:
RESILIENT was a randomized, prospective, multicenter, controlled trial assessing the safety and efficacy of thrombectomy versus medical treatment alone. A total of 221 patients were enrolled. The trial showed a substantial benefit of MT when added to medical management. All eligible patients received intravenous tPA within the 4.5-h-window. Ordinal logistic and binary regression analyses using intravenous tPA as an interaction term were performed with adjustments for potential confounders, including age, baseline NIHSS score, occlusion site, and ASPECTS. A p-value <0.05 was considered statistically significant.RESULTS:
Among 221 randomized patients (median NIHSS, 18 IQR [14-21]), 155 (70%) were treated with IVT. There was no difference in the mRS ordinal shift and frequency of functional independence between patients who received or not IV tPA; the odds ratio for the ordinal mRS shift was 2.63 [1.48-4.69] for the IVT group and 1.54 [0.63-3.74] for the no IVT group, with a p-value of 0.42. IVT also did not affect the frequency of good recanalization (TICI 2b or higher) and hemorrhagic transformation.CONCLUSIONS:
The large effect size of MT on LVO outcomes was not significantly affected by IVT. TRIAL REGISTRATION RESILIENT ClinicalTrials.gov number, NCT02216643.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Arterial Occlusive Diseases
/
Brain Ischemia
/
Stroke
/
Mechanical Thrombolysis
/
Ischemic Stroke
Type of study:
Clinical_trials
Limits:
Humans
Language:
En
Journal:
J Neurol Sci
/
J. neurol. sci
/
Journal of the neurological sciences
Year:
2024
Document type:
Article
Country of publication: