Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial.
Details
Serval ID
serval:BIB_CAE520DCCFDE
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Interaction between intravenous thrombolysis and clinical outcome between slow and fast progressors undergoing mechanical thrombectomy: a post-hoc analysis of the SWIFT-DIRECT trial.
Journal
Journal of neurointerventional surgery
Working group(s)
SWIFT-DIRECT investigators
Contributor(s)
Fischer U., Kaesmacher J., Strbian D., Eker O., Cognard C., Plattner P.S., Bütikofer L., Mordasini P., Deppeler S., Mendes-Pereira V., Albucher J.F., Darcourt J., Bourcier R., Guillon B., Papagiannaki C., Ozkul-Wermester O., Sibolt G., Tiainen M., Gory B., Richard S., Liman J., Ernst M.S., Boulanger M., Barbier C., Mechtouff L., Zhang L., Marnat G., Sibon I., Nikoubashman O., Reich A., Consoli A., Lapergue B., Ribo M., Tomasello A., Saleme S., Macian F., Moulin S., Pagano P., Salliou G., Carrera E., Janot K., Hernández-Pérez M., Pop R., Schiava L.D., Luft A.R., Piotin M., Gentric J.C., Pikula A., Pfeilschifter W., Arnold M., Siddiqui A.H., Froehler M.T., Furlan A.J., Chapot R., Wiesmann M., Machi P., Diener H.C., Kulcsar Z., Bonati L., Bassetti C.L., Mazighi M., Liebeskind D.S., Saver J.L., Gralla J., Schmidhalter M., Bressan J., Lerch S., Limacher A., Meyenn L.V., Zimmermann M., Campbell B., Friede T., Kummer R.V., Alonso A., Arquizan C., Barreau X., Beaujeux R., Behme D., Boeckh-Behrens T., Boehme C., Boix M., Boulouis G., Bricout N., Broc N., Cereda C.W., Chabert E., Cho T.H., Cianfoni A., Costalat V., Denier C., Maria F.D., Rochemont RDM, Fearon P., Ferrier A., Fischer S., Gauberti M., Gaudron M., Gimenez L., Globas C., Görtler M., Goyal M., Hilker-Roggendorf R., Hill M.D., Hua V.T., Humbertjean L., Jansen O., Jung S., Kägi G., Kelly M.E., Kleffner I., Knoflach M., Nedeltchev K., Krause L.U., Lappalainen K., Lefebvre M., Leyon J., Liao L., Liegey J.S., Loehr C., Michel P., Nannoni S., Nicholson P., Nico L., Obadia M., Ognard J., Ogungbemi A., Olivot J.M., Escalard S., Pasi M., Peeling L., Perez J., Petersen M., Piechowiak E., Raposo R., Räty S., Reitz S.C., Remollo S., Remonda L., Rennie I., Requena M., Riabikin A., Riva R., Rouchaud A., Rosi A., Rubiera M., Spelle L., Schnieder M., Schaafsma J.D., Schubert T., Schulz J.B., Siddiqui M., Soize S., Sonnberger M., Touze E., Triquenot A., Turc G., Vieira L., Hassen W.B., Wagner J.N., Wasser K., Weber J., Weisenburger-Lile D., Wodarg F., Wolff V., Wunderlich S.
ISSN
1759-8486 (Electronic)
ISSN-L
1759-8478
Publication state
Published
Issued date
19/12/2023
Peer-reviewed
Oui
Editor
Fischer U Kaesmacher J. Strbian D. Eker O. Cognard C. Plattner P. S. Butikofer L. Mordasini P. Deppeler S. Mendes-Pereira V. Albucher J. F. Darcourt J. Bourcier R. Guillon B. Papagiannaki C. Ozkul-Wermester O. Sibolt G. Tiainen M. Gory B. Richard S. Liman J. Ernst M. S. Boulanger M. Barbier C. Mechtouff L. Zhang L. Marnat G. Sibon I. Nikoubashman O. Reich A. Consoli A. Lapergue B. Ribo M. Tomasello A. Saleme S. Macian F. Moulin S. Pagano P. Salliou G. Carrera E. Janot K. Hernandez-Perez M. Pop R. Schiava L. D. Luft A. R. Piotin M. Gentric J. C. Pikula A. Pfeilschifter W. Arnold M. Siddiqui A. H. Froehler M. T. Furlan A. J. Chapot R. Wiesmann M. Machi P. Diener H. C. Kulcsar Z. Bonati L. Bassetti C. L. Mazighi M. Liebeskind D. S. Saver J. L. Gralla J. Schmidhalter M. Bressan J. Lerch S. Limacher A. Meyenn L. V. Zimmermann M. Campbell B. Friede T. Kummer R. V. Alonso A. Arquizan C. Barreau X. Beaujeux R. Behme D. Boeckh-Behrens T. Boehme C. Boix M. Boulouis G. Bricout N. Broc N. Cereda C. W. Chabert E. Cho T. H. Cianfoni A. Costalat V. Denier C. Maria F. D. Rochemont R. D. M. Fearon P. Ferrier A. Fischer S. Gauberti M. Gaudron M. Gimenez L. Globas C. Gortler M. Goyal M. Hilker-Roggendorf R. Hill M. D. Hua V. T. Humbertjean L. Jansen O. Jung S. Kagi G. Kelly M. E. Kleffner I. Knoflach M. Nedeltchev K. Krause L. U. Lappalainen K. Lefebvre M. Leyon J. Liao L. Liegey J. S. Loehr C. Michel P. Nannoni S. Nicholson P. Nico L. Obadia M. Ognard J. Ogungbemi A. Olivot J. M. Escalard S. Pasi M. Peeling L. Perez J. Petersen M. Piechowiak E. Raposo R. Raty S. Reitz S. C. Remollo S. Remonda L. Rennie I. Requena M. Riabikin A. Riva R. Rouchaud A. Rosi A. Rubiera M. Spelle L. Schnieder M. Schaafsma J. D. Schubert T. Schulz J. B. Siddiqui M. Soize S. Sonnberger M. Touze E. Triquenot A. Turc G. Vieira L. Hassen W. B. Wagner J. N. Wasser K. Weber J. Weisenburger-Lile D. Wodarg F. Wolff V. Wunderlich S.
Volume
16
Number
1
Pages
45-52
Language
english
Notes
Publication types: Randomized Controlled Trial ; Journal Article
Publication Status: epublish
Publication Status: epublish
Abstract
In proximal occlusions, the effect of reperfusion therapies may differ between slow or fast progressors. We investigated the effect of intravenous thrombolysis (IVT) (with alteplase) plus mechanical thrombectomy (MT) versus thrombectomy alone among slow versus fast stroke progressors.
The SWIFT-DIRECT trial data were analyzed: 408 patients randomized to IVT+MT or MT alone. Infarct growth speed was defined by the number of points of decay in the initial Alberta Stroke Program Early CT Score (ASPECTS) divided by the onset-to-imaging time. The primary endpoint was 3-month functional independence (modified Rankin scale 0-2). In the primary analysis, the study population was dichotomized into slow and fast progressors using median infarct growth velocity. Secondary analysis was also conducted using quartiles of ASPECTS decay.
We included 376 patients: 191 IVT+MT, 185 MT alone; median age 73 years (IQR 65-81); median initial National Institutes of Health Stroke Scale (NIHSS) 17 (IQR 13-20). The median infarct growth velocity was 1.2 points/hour. Overall, we did not observe a significant interaction between the infarct growth speed and the allocation to either randomization group on the odds of favourable outcome (P=0.68). In the IVT+MT group, odds of any intracranial hemorrhage (ICH) were significantly lower in slow progressors (22.8% vs 36.4%; OR 0.52, 95% CI 0.27 to 0.98) and higher among fast progressors (49.4% vs 26.8%; OR 2.62, 95% CI 1.42 to 4.82) (P value for interaction <0.001). Similar results were observed in secondary analyses.
In this SWIFT-DIRECT subanalysis, we did not find evidence for a significant interaction of the velocity of infarct growth on the odds of favourable outcome according to treatment by MT alone or combined IVT+MT. However, prior IVT was associated with significantly reduced occurrence of any ICH among slow progressors whereas this was increased in fast progressors.
The SWIFT-DIRECT trial data were analyzed: 408 patients randomized to IVT+MT or MT alone. Infarct growth speed was defined by the number of points of decay in the initial Alberta Stroke Program Early CT Score (ASPECTS) divided by the onset-to-imaging time. The primary endpoint was 3-month functional independence (modified Rankin scale 0-2). In the primary analysis, the study population was dichotomized into slow and fast progressors using median infarct growth velocity. Secondary analysis was also conducted using quartiles of ASPECTS decay.
We included 376 patients: 191 IVT+MT, 185 MT alone; median age 73 years (IQR 65-81); median initial National Institutes of Health Stroke Scale (NIHSS) 17 (IQR 13-20). The median infarct growth velocity was 1.2 points/hour. Overall, we did not observe a significant interaction between the infarct growth speed and the allocation to either randomization group on the odds of favourable outcome (P=0.68). In the IVT+MT group, odds of any intracranial hemorrhage (ICH) were significantly lower in slow progressors (22.8% vs 36.4%; OR 0.52, 95% CI 0.27 to 0.98) and higher among fast progressors (49.4% vs 26.8%; OR 2.62, 95% CI 1.42 to 4.82) (P value for interaction <0.001). Similar results were observed in secondary analyses.
In this SWIFT-DIRECT subanalysis, we did not find evidence for a significant interaction of the velocity of infarct growth on the odds of favourable outcome according to treatment by MT alone or combined IVT+MT. However, prior IVT was associated with significantly reduced occurrence of any ICH among slow progressors whereas this was increased in fast progressors.
Keywords
Humans, Aged, Treatment Outcome, Stroke/diagnostic imaging, Stroke/drug therapy, Stroke/surgery, Thrombectomy/methods, Thrombolytic Therapy/methods, Intracranial Hemorrhages/complications, Infarction/complications, Infarction/drug therapy, Brain Ischemia/therapy, Fibrinolytic Agents/therapeutic use, Mechanical Thrombolysis/methods, hemorrhage, stroke, thrombectomy, thrombolysis
Pubmed
Web of science
Create date
17/04/2023 12:11
Last modification date
11/01/2024 7:14
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