Clinical imaging factors of excellent outcome after thrombolysis in large-vessel stroke: a THRACE subgroup analysis

Stroke and Vascular Neurology

article

Nolwenn Riou-Comte¹  Benjamin Gory²  Marc Soudant³  François Zhu²  Yu Xie²  Lisa Humbertjean¹  Gioia Mione¹  Catherine Oppenheim⁴  Francis Guillemin³  Serge Bracard²  Sébastien Richard⁵ 

[1] Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116 , Université de Lorraine, Nancy Regional University Hospital Center;Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI , Université de Lorraine, Nancy Regional University Hospital Center;Clinical Investigation Centre-Clinical Epidemiology 1433, INSERM , Université de Lorraine, Nancy Regional University Hospital Center;Department of Neuroradiology, INSERM U894 , Université Paris-Descartes, Sainte-Anne Hospital;1 Department of Neurology-Stroke Unit, CIC-P 1433, INSERMU1116 , Université de Lorraine, Nancy Regional University Hospital Center , Nancy , France 2 Department of Diagnostic and Therapeutic Neuroradiology, INSERM U1254, IADI , Université de Lorraine, Nancy Regional University Hospital Center , Nancy , France 3 Clinical Investigation Centre-Clinical Epidemiology 1433, INSERM , Université de Lorraine, Nancy Regional University Hospital Center , Nancy , France 4 Department of Neuroradiology, INSERM U894 , Université Paris-Descartes, Sainte-Anne Hospital

关键词: stroke;    thrombolysis;    thrombectomy;   

DOI  :  10.1136/svn-2020-000852

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Background For patients with stroke with large-vessel occlusion (LVO), study of factors predicting response to intravenous thrombolysis (IVT) would allow identifying subgroups with high expected gain, and those for whom it could be considered as futile, and even detrimental. From patients included in the Mechanical Thrombectomy After Intravenous Alteplase vs Alteplase Alone After Stroke trial, we investigated clinical-imaging factors associated with optimal response to IVT.Methods We included patients receiving IVT alone. Excellent outcome was defined by a 3-month modified Rankin Scale (mRS) score ≤1. Clinical-imaging predictors were assessed on multivariate analysis after multiple imputations. The predictive performance of the model was assessed with the C-statistic.Results Among 247 patients with LVO treated with IVT alone, 77 (31%) showed 3-month mRS ≤1. Predictors of 3-month mRS ≤1 were no medical history of hypertension (OR 2.43; 95% CI 1.74 to 3.38; p=0.007); no current smoking (OR 2.76; 95% CI 1.79 to 4.26; p=0.02); onset-to-IVT time (OR 0.47 per hour increase; 95% CI 0.23 to 0.78; p=0.003); diffusion-weighted imaging (DWI) volume (OR 0.78 per 10 mL increase; 95% CI 0.68 to 0.89; p=0.0004); presence of susceptibility vessel sign (SVS) (OR 7.89; 95% CI 1.65 to 37.78; p=0.01) and SVS length (OR 0.87 per mm increase; 95% CI 0.80 to 0.94; p=0.001). The prediction models showed a C-statistic=0.79 (95% CI 0.79 to 0.80).Conclusions In patients with stroke with anterior-circulation LVO treated with IVT alone, predictors of excellent outcome at 3 months were no medical history of hypertension or current smoking, reduced onset-to-IVT time, small DWI volume, presence of SVS and short SVS length. These predictive factors could help practitioners in decision-making for IVT implementation in reperfusion strategies, all the more for the drip and ship paradigm.Trial registration numberNCT01062698.

【 授权许可】

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