Intra-arterial thrombolytics during endovascular thrombectomy for acute ischaemic stroke in the MR CLEAN Registry

Stroke and Vascular Neurology

article

Sabine L Collette¹  Reinoud P H Bokkers¹  Aryan Mazuri¹  Geert J Lycklama à Nijeholt²  Robert J van Oostenbrugge³  Natalie E LeCouffe⁴  Faysal Benali⁵  Charles B L M Majoie⁶  Jan Cees de Groot¹  Gert Jan R Luijckx⁷  Maarten Uyttenboogaart¹ 

[1] Department of Radiology, Medical Imaging Centre , University Medical Centre Groningen, University of Groningen;Department of Radiology , Haaglanden Medical Centre;Department of Neurology , Cardiovascular Research Institute Maastricht ,(CARIM), Maastricht University Medical Centre;Department of Neurology , Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience;Department of Radiology , Maastricht University Medical Centre;Department of Radiology and Nuclear Medicine , Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience;Department of Neurology , University Medical Centre Groningen, University of Groningen

关键词: Stroke;    Thrombectomy;    Thrombolytic Therapy;   

DOI  :  10.1136/svn-2022-001677

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Introduction The efficacy and safety of local intra-arterial (IA) thrombolytics during endovascular thrombectomy (EVT) for large-vessel occlusions is uncertain. We analysed how often IA thrombolytics were administered in the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) Registry, whether it was associated with improved functional outcome and assessed technical and safety outcomes compared with EVT without IA thrombolytics.Methods In this observational study, we included patients undergoing EVT for an acute ischaemic stroke in the anterior circulation from the MR CLEAN Registry (March 2014–November 2017). The primary endpoint was favourable functional outcome, defined as an modified Rankin Scale score ≤2 at 90 days. Secondary endpoints were reperfusion status, early neurological recovery and symptomatic intracranial haemorrhage (sICH). Subgroup analyses for IA thrombolytics as primary versus adjuvant revascularisation attempt were performed.Results Of the 2263 included patients, 95 (4.2%) received IA thrombolytics during EVT. The IA thrombolytics administered were urokinase (median dose, 250 000 IU (IQR, 1 93 750–2 50 000)) or alteplase (median dose, 20 mg (IQR, 12–20)). No association was found between IA thrombolytics and favourable functional outcome (adjusted OR (aOR), 1.16; 95% CI 0.71 to 1.90). Successful reperfusion was less often observed in those patients treated with IA thrombolytics (aOR, 0.57; 95% CI 0.36 to 0.90). The odds of sICH (aOR, 0.82; 95% CI 0.32 to 2.10) and early neurological recovery were comparable between patients treated with and without IA thrombolytics. For primary and adjuvant revascularisation attempts, IA thrombolytics were more often administered for proximal than for distal occlusions. Functional outcomes were comparable for patients receiving IA thrombolytics as a primary versus adjuvant revascularisation attempt.Conclusion Local IA thrombolytics were rarely used in the MR CLEAN Registry. In the relatively small study sample, no statistical difference was observed between groups in the rate of favourable functional outcome or sICH. Patients whom required and underwent IA thrombolytics were patients less likely to achieve successful reperfusion, probably due to selection bias.

【 授权许可】

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