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Intravenous Thrombolysis 4.5-9 Hours After Stroke Onset: A Cohort Study from the TRISP Collaboration.
Altersberger, Valerian L; Sibolt, Gerli; Enz, Lukas S; Hametner, Christian; Scheitz, Jan F; Henon, Hilde; Bigliardi, Guido; Strambo, Davide; Martinez-Majander, Nicolas; Stolze, Lotte J; Heldner, Mirjam R; Grisendi, Ilaria; Jovanovic, Dejana R; Bejot, Yannick; Pezzini, Alessandro; Leker, Ronen R; Kägi, Georg; Wegener, Susanne; Cereda, Carlo W; Ntaios, Georges; De Marchis, Gian Marco; Bonati, Leo H; Psychogios, Marios; Lyrer, Philippe; Räty, Silja; Tiainen, Marjaana; Wouters, Anke; Caparros, François; Heyse, Miriam; Erdur, Hebun; Padjen, Visnja; Zedde, Marialuisa; Arnold, Marcel; Nederkoorn, Paul J; Michel, Patrik; Zini, Andrea; Cordonnier, Charlotte; Nolte, Christian H; Ringleb, Peter A; Curtze, Sami; Engelter, Stefan T; Gensicke, Henrik.
Affiliation
  • Altersberger VL; Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Sibolt G; Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Enz LS; Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Hametner C; Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
  • Scheitz JF; Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Henon H; Univ. Lille, Inserm, CHU Lille Lille Neuroscience & Cognition, Lille, France.
  • Bigliardi G; Stroke Unit, Department of Neuroscience, Ospedale Civile di Baggiovara, Modena University Hospital, Modena, Italy.
  • Strambo D; Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
  • Martinez-Majander N; Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Stolze LJ; Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Heldner MR; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Grisendi I; Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Jovanovic DR; Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
  • Bejot Y; Department of Neurology, University Hospital Dijon, Dijon, France.
  • Pezzini A; Neurology Clinic, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
  • Leker RR; Department of Neurological Sciences and Vision, ASST Spedali Civili, Brescia, Italy.
  • Kägi G; Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
  • Wegener S; Department of Neurology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
  • Cereda CW; Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
  • Ntaios G; Stroke Center and Department of Neurology, Neurocenter of Southern Switzerland, Lugano, Switzerland.
  • De Marchis GM; Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
  • Bonati LH; Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Psychogios M; Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Lyrer P; Department of Neuroradiology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Räty S; Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
  • Tiainen M; Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Wouters A; Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Caparros F; Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Heyse M; Univ. Lille, Inserm, CHU Lille Lille Neuroscience & Cognition, Lille, France.
  • Erdur H; Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
  • Padjen V; Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Zedde M; Neurology Clinic, University Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
  • Arnold M; Neurology Unit-Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Nederkoorn PJ; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
  • Michel P; Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
  • Zini A; Stroke Center, Neurology Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
  • Cordonnier C; IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy.
  • Nolte CH; Univ. Lille, Inserm, CHU Lille Lille Neuroscience & Cognition, Lille, France.
  • Ringleb PA; Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Germany and Center for Stroke Research Berlin (CSB), Charité-Universitätsmedizin Berlin, Berlin, Germany.
  • Curtze S; Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany.
  • Engelter ST; Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Gensicke H; Stroke Center and Department of Neurology, University Hospital Basel and University of Basel, Basel, Switzerland.
Ann Neurol ; 94(2): 309-320, 2023 08.
Article in En | MEDLINE | ID: mdl-37114466
ABSTRACT

OBJECTIVE:

To investigate the safety and effectiveness of intravenous thrombolysis (IVT) >4.5-9 hours after stroke onset, and the relevance of advanced neuroimaging for patient selection.

METHODS:

Prospective multicenter cohort study from the ThRombolysis in Ischemic Stroke Patients (TRISP) collaboration. Outcomes were symptomatic intracranial hemorrhage, poor 3-month functional outcome (modified Rankin scale 3-6) and mortality. We compared (i) IVT >4.5-9 hours versus 0-4.5 hours after stroke onset and (ii) within the >4.5-9 hours group baseline advanced neuroimaging (computed tomography perfusion, magnetic resonance perfusion or magnetic resonance diffusion-weighted imaging fluid-attenuated inversion recovery) versus non-advanced neuroimaging.

RESULTS:

Of 15,827 patients, 663 (4.2%) received IVT >4.5-9 hours and 15,164 (95.8%) within 4.5 hours after stroke onset. The main baseline characteristics were evenly distributed between both groups. Time of stroke onset was known in 74.9% of patients treated between >4.5 and 9 hours. Using propensity score weighted binary logistic regression analysis (onset-to-treatment time >4.5-9 hours vs onset-to-treatment time 0-4.5 hours), the probability of symptomatic intracranial hemorrhage (ORadjusted 0.80, 95% CI 0.53-1.17), poor functional outcome (ORadjusted 1.01, 95% CI 0.83-1.22), and mortality (ORadjusted 0.80, 95% CI 0.61-1.04) did not differ significantly between both groups. In patients treated between >4.5 and 9 hours, the use of advanced neuroimaging was associated with a 50% lower mortality compared with non-advanced imaging only (9.9% vs 19.7%; ORadjusted 0.51, 95% CI 0.33-0.79).

INTERPRETATION:

This study showed no evidence in difference of symptomatic intracranial hemorrhage, poor outcome, and mortality in selected stroke patients treated with IVT between >4.5 and 9 hours after stroke onset compared with those treated within 4.5 hours. Advanced neuroimaging for patient selection was associated with lower mortality. ANN NEUROL 2023;94309-320.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Ischemia / Stroke / Ischemic Stroke Type of study: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limits: Humans Language: En Journal: Ann Neurol Year: 2023 Document type: Article Affiliation country: Suiza
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Brain Ischemia / Stroke / Ischemic Stroke Type of study: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Risk_factors_studies Limits: Humans Language: En Journal: Ann Neurol Year: 2023 Document type: Article Affiliation country: Suiza