Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone

Katinka R van Kranendonk; Manon Kappelhof; Agnetha A E Bruggeman; Leon A Rinkel; Kilian M Treurniet; Natalie LeCouffe; Bart J Emmer; Jonathan M Coutinho; Lennard Wolff; Wim H van Zwam; Robert J van Oostenbrugge; Aad van der Lugt; Diederik W J Dippel; Yvo B W E M Roos; Henk A Marquering; Charles B L M Majoie; MR CLEAN-NO IV Investigators

doi:10.1136/jnis-2022-019569

Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone

Katinka R van Kranendonk^*, Manon Kappelhof, Agnetha A E Bruggeman, Leon A Rinkel, Kilian M Treurniet, Natalie LeCouffe, Bart J Emmer, Jonathan M Coutinho, Lennard Wolff, Wim H van Zwam, Robert J van Oostenbrugge, Aad van der Lugt, Diederik W J Dippel, Yvo B W E M Roos, Henk A Marquering, Charles B L M Majoie, MR CLEAN-NO IV Investigators

^*Corresponding author for this work

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Abstract

BACKGROUND: Intravenous alteplase treatment (IVT) for acute ischemic stroke carries a risk of intracranial hemorrhage (ICH). However, reperfusion of an occluded vessel itself may contribute to the risk of ICH. We determined whether IVT and reperfusion are associated with ICH or its volume in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN)-NO IV trial.

METHODS: The MR CLEAN-NO IV trial randomized patients with acute ischemic stroke due to large vessel occlusion to receive either IVT followed by endovascular treatment (EVT) or EVT alone. ICH was classified according to the Heidelberg bleeding classification on follow-up MRI or CT approximately 8 hours-7 days after stroke. Hemorrhage volume was measured with ITK-snap. Successful reperfusion was defined as extended Thrombolysis In Cerebral Infarction (eTICI) score of 2b-3. Multinomial and binary adjusted logistic regression were used to determine the association of IVT and reperfusion with ICH subtypes.

RESULTS: Of 539 included patients, 173 (32%) developed ICH and 30 suffered from symptomatic ICH (sICH) (6%). Of the patients with ICH, 102 had hemorrhagic infarction, 47 had parenchymal hematoma, 44 had SAH, and six had other ICH. Reperfusion was associated with a decreased risk of SAH, and IVT was not associated with SAH (eTICI 2b-3: adjusted OR 0.45, 95% CI 0.21 to 0.97; EVT without IVT: OR 1.6, 95% CI 0.91 to 2.8). Reperfusion status and IVT were not associated with overall ICH, hemorrhage volume, and sICH (sICH: EVT without IVT, OR 0.96, 95% CI 0.41 to 2.25; eTICI 2b-3, OR 0.49, 95% CI 0.23 to 1.05).

CONCLUSION: Neither IVT administration before EVT nor successful reperfusion after EVT were associated with ICH, hemorrhage volume, and sICH. SAH occurred more often in patients for whom successful reperfusion was not achieved.

Original language	English
Pages (from-to)	E262-E269
Number of pages	8
Journal	Journal of Neurointerventional Surgery
Volume	15
Issue number	E2
Early online date	17 Nov 2022
DOIs	https://doi.org/10.1136/jnis-2022-019569
Publication status	Published - 2023

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van Kranendonk, K. R., Kappelhof, M., Bruggeman, A. A. E., Rinkel, L. A., Treurniet, K. M., LeCouffe, N., Emmer, B. J., Coutinho, J. M., Wolff, L., van Zwam, W. H., van Oostenbrugge, R. J., van der Lugt, A., Dippel, D. W. J., Roos, Y. B. W. E. M., Marquering, H. A., Majoie, C. B. L. M., & MR CLEAN-NO IV Investigators (2023). Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone. Journal of Neurointerventional Surgery, 15(E2), E262-E269. https://doi.org/10.1136/jnis-2022-019569

@article{29a511dcef6646a3b056797d9a1ce224,

title = "Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone",

abstract = "BACKGROUND: Intravenous alteplase treatment (IVT) for acute ischemic stroke carries a risk of intracranial hemorrhage (ICH). However, reperfusion of an occluded vessel itself may contribute to the risk of ICH. We determined whether IVT and reperfusion are associated with ICH or its volume in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN)-NO IV trial.METHODS: The MR CLEAN-NO IV trial randomized patients with acute ischemic stroke due to large vessel occlusion to receive either IVT followed by endovascular treatment (EVT) or EVT alone. ICH was classified according to the Heidelberg bleeding classification on follow-up MRI or CT approximately 8 hours-7 days after stroke. Hemorrhage volume was measured with ITK-snap. Successful reperfusion was defined as extended Thrombolysis In Cerebral Infarction (eTICI) score of 2b-3. Multinomial and binary adjusted logistic regression were used to determine the association of IVT and reperfusion with ICH subtypes.RESULTS: Of 539 included patients, 173 (32%) developed ICH and 30 suffered from symptomatic ICH (sICH) (6%). Of the patients with ICH, 102 had hemorrhagic infarction, 47 had parenchymal hematoma, 44 had SAH, and six had other ICH. Reperfusion was associated with a decreased risk of SAH, and IVT was not associated with SAH (eTICI 2b-3: adjusted OR 0.45, 95% CI 0.21 to 0.97; EVT without IVT: OR 1.6, 95% CI 0.91 to 2.8). Reperfusion status and IVT were not associated with overall ICH, hemorrhage volume, and sICH (sICH: EVT without IVT, OR 0.96, 95% CI 0.41 to 2.25; eTICI 2b-3, OR 0.49, 95% CI 0.23 to 1.05).CONCLUSION: Neither IVT administration before EVT nor successful reperfusion after EVT were associated with ICH, hemorrhage volume, and sICH. SAH occurred more often in patients for whom successful reperfusion was not achieved.",

author = "{van Kranendonk}, {Katinka R} and Manon Kappelhof and Bruggeman, {Agnetha A E} and Rinkel, {Leon A} and Treurniet, {Kilian M} and Natalie LeCouffe and Emmer, {Bart J} and Coutinho, {Jonathan M} and Lennard Wolff and {van Zwam}, {Wim H} and {van Oostenbrugge}, {Robert J} and {van der Lugt}, Aad and Dippel, {Diederik W J} and Roos, {Yvo B W E M} and Marquering, {Henk A} and Majoie, {Charles B L M} and {MR CLEAN-NO IV Investigators}",

note = "{\textcopyright} Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2023",

doi = "10.1136/jnis-2022-019569",

language = "English",

volume = "15",

pages = "E262--E269",

journal = "Journal of Neurointerventional Surgery",

issn = "1759-8478",

publisher = "BMJ Publishing Group",

number = "E2",

}

van Kranendonk, KR, Kappelhof, M, Bruggeman, AAE, Rinkel, LA, Treurniet, KM, LeCouffe, N, Emmer, BJ, Coutinho, JM, Wolff, L, van Zwam, WH , van Oostenbrugge, RJ, van der Lugt, A, Dippel, DWJ, Roos, YBWEM, Marquering, HA, Majoie, CBLM & MR CLEAN-NO IV Investigators 2023, 'Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone', Journal of Neurointerventional Surgery, vol. 15, no. E2, pp. E262-E269. https://doi.org/10.1136/jnis-2022-019569

Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone. / van Kranendonk, Katinka R; Kappelhof, Manon; Bruggeman, Agnetha A E et al.
In: Journal of Neurointerventional Surgery, Vol. 15, No. E2, 2023, p. E262-E269.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone

AU - van Kranendonk, Katinka R

AU - Kappelhof, Manon

AU - Bruggeman, Agnetha A E

AU - Rinkel, Leon A

AU - Treurniet, Kilian M

AU - LeCouffe, Natalie

AU - Emmer, Bart J

AU - Coutinho, Jonathan M

AU - Wolff, Lennard

AU - van Zwam, Wim H

AU - van Oostenbrugge, Robert J

AU - van der Lugt, Aad

AU - Dippel, Diederik W J

AU - Roos, Yvo B W E M

AU - Marquering, Henk A

AU - Majoie, Charles B L M

AU - MR CLEAN-NO IV Investigators

PY - 2023

Y1 - 2023

N2 - BACKGROUND: Intravenous alteplase treatment (IVT) for acute ischemic stroke carries a risk of intracranial hemorrhage (ICH). However, reperfusion of an occluded vessel itself may contribute to the risk of ICH. We determined whether IVT and reperfusion are associated with ICH or its volume in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN)-NO IV trial.METHODS: The MR CLEAN-NO IV trial randomized patients with acute ischemic stroke due to large vessel occlusion to receive either IVT followed by endovascular treatment (EVT) or EVT alone. ICH was classified according to the Heidelberg bleeding classification on follow-up MRI or CT approximately 8 hours-7 days after stroke. Hemorrhage volume was measured with ITK-snap. Successful reperfusion was defined as extended Thrombolysis In Cerebral Infarction (eTICI) score of 2b-3. Multinomial and binary adjusted logistic regression were used to determine the association of IVT and reperfusion with ICH subtypes.RESULTS: Of 539 included patients, 173 (32%) developed ICH and 30 suffered from symptomatic ICH (sICH) (6%). Of the patients with ICH, 102 had hemorrhagic infarction, 47 had parenchymal hematoma, 44 had SAH, and six had other ICH. Reperfusion was associated with a decreased risk of SAH, and IVT was not associated with SAH (eTICI 2b-3: adjusted OR 0.45, 95% CI 0.21 to 0.97; EVT without IVT: OR 1.6, 95% CI 0.91 to 2.8). Reperfusion status and IVT were not associated with overall ICH, hemorrhage volume, and sICH (sICH: EVT without IVT, OR 0.96, 95% CI 0.41 to 2.25; eTICI 2b-3, OR 0.49, 95% CI 0.23 to 1.05).CONCLUSION: Neither IVT administration before EVT nor successful reperfusion after EVT were associated with ICH, hemorrhage volume, and sICH. SAH occurred more often in patients for whom successful reperfusion was not achieved.

AB - BACKGROUND: Intravenous alteplase treatment (IVT) for acute ischemic stroke carries a risk of intracranial hemorrhage (ICH). However, reperfusion of an occluded vessel itself may contribute to the risk of ICH. We determined whether IVT and reperfusion are associated with ICH or its volume in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN)-NO IV trial.METHODS: The MR CLEAN-NO IV trial randomized patients with acute ischemic stroke due to large vessel occlusion to receive either IVT followed by endovascular treatment (EVT) or EVT alone. ICH was classified according to the Heidelberg bleeding classification on follow-up MRI or CT approximately 8 hours-7 days after stroke. Hemorrhage volume was measured with ITK-snap. Successful reperfusion was defined as extended Thrombolysis In Cerebral Infarction (eTICI) score of 2b-3. Multinomial and binary adjusted logistic regression were used to determine the association of IVT and reperfusion with ICH subtypes.RESULTS: Of 539 included patients, 173 (32%) developed ICH and 30 suffered from symptomatic ICH (sICH) (6%). Of the patients with ICH, 102 had hemorrhagic infarction, 47 had parenchymal hematoma, 44 had SAH, and six had other ICH. Reperfusion was associated with a decreased risk of SAH, and IVT was not associated with SAH (eTICI 2b-3: adjusted OR 0.45, 95% CI 0.21 to 0.97; EVT without IVT: OR 1.6, 95% CI 0.91 to 2.8). Reperfusion status and IVT were not associated with overall ICH, hemorrhage volume, and sICH (sICH: EVT without IVT, OR 0.96, 95% CI 0.41 to 2.25; eTICI 2b-3, OR 0.49, 95% CI 0.23 to 1.05).CONCLUSION: Neither IVT administration before EVT nor successful reperfusion after EVT were associated with ICH, hemorrhage volume, and sICH. SAH occurred more often in patients for whom successful reperfusion was not achieved.

U2 - 10.1136/jnis-2022-019569

DO - 10.1136/jnis-2022-019569

M3 - Article

C2 - 36396434

SN - 1759-8478

VL - 15

SP - E262-E269

JO - Journal of Neurointerventional Surgery

JF - Journal of Neurointerventional Surgery

IS - E2

ER -