TY - JOUR
T1 - Intravenous Thrombolysis Is Not Associated with Increased Time to Endovascular Treatment
AU - Hinsenveld, Wouter H.
AU - de Ridder, Inger R.
AU - van Oostenbrugge, Robert J.
AU - van Zwam, Wim H.
AU - Vos, Jan Albert
AU - Coutinho, Jonathan M.
AU - Nijeholt, Geert J. Lycklama a
AU - Boiten, Jelis
AU - Schonewille, Wouter J.
AU - MR CLEAN Registry Investigators
N1 - Funding Information:
The MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke) was partly funded by Stichting Toegepast Wetenschappelijk Instituut voor Neuromodulatie (TWIN), Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam University Medical Center. Maastricht UMC received funds from Stryker® and Cerenovus® for consultations by Wim van Zwam.
Publisher Copyright:
© 2020 S. Karger AG. All rights reserved.
PY - 2020/7
Y1 - 2020/7
N2 - Background:Endovascular treatment (EVT) with or without intravenous thrombolysis (IVT) is effective and safe in is-chemic stroke caused by large vessel occlusion, but IVT might delay time to EVT or increase risk of intracranial hemorrhage (ICH). We assessed the influence of prior IVT on time to treatment and risk of ICH in patients treated with EVT.Methods:We analyzed data from the MR CLEAN Registry and included patients with an anterior circulation occlusion treated with EVT who presented directly to an intervention center, between 2014 and 2017. Primary endpoint was the door to groin time. Secondary outcomes were workflow time intervals and safety outcomes. We compared patients who received EVT only with patients who received IVT prior to EVT.Results:We included 1,427 patients directly referred to an intervention center of whom 1,023 (72%) received IVT + EVT. Adjusted door to CT imaging and door to groin time were shorter in IVT + EVT patients (difference 5.7 min [95% CI: 4.6-6.8] and 7.0 min [95% CI: 2.4-12], respectively) while CT imaging to groin time was similar between the groups. Early recanalization on digital subtraction angiography before EVT was seen more often after prior IVT (11 vs. 5.2%, aOR 2.4 [95% CI: 1.4-4.2]). Rates of symptomatic ICH were similar.Conclusion:Prior IVT did not delay door to groin times and was associated with higher rates of early recanalization, without increasing the risk of ICH. Our results do not warrant withholding IVT prior to EVT.
AB - Background:Endovascular treatment (EVT) with or without intravenous thrombolysis (IVT) is effective and safe in is-chemic stroke caused by large vessel occlusion, but IVT might delay time to EVT or increase risk of intracranial hemorrhage (ICH). We assessed the influence of prior IVT on time to treatment and risk of ICH in patients treated with EVT.Methods:We analyzed data from the MR CLEAN Registry and included patients with an anterior circulation occlusion treated with EVT who presented directly to an intervention center, between 2014 and 2017. Primary endpoint was the door to groin time. Secondary outcomes were workflow time intervals and safety outcomes. We compared patients who received EVT only with patients who received IVT prior to EVT.Results:We included 1,427 patients directly referred to an intervention center of whom 1,023 (72%) received IVT + EVT. Adjusted door to CT imaging and door to groin time were shorter in IVT + EVT patients (difference 5.7 min [95% CI: 4.6-6.8] and 7.0 min [95% CI: 2.4-12], respectively) while CT imaging to groin time was similar between the groups. Early recanalization on digital subtraction angiography before EVT was seen more often after prior IVT (11 vs. 5.2%, aOR 2.4 [95% CI: 1.4-4.2]). Rates of symptomatic ICH were similar.Conclusion:Prior IVT did not delay door to groin times and was associated with higher rates of early recanalization, without increasing the risk of ICH. Our results do not warrant withholding IVT prior to EVT.
KW - Acute stroke intervention
KW - Endovascular treatment of acute stroke
KW - Intravenous thrombolytic therapy of stroke
KW - Stroke organization
KW - Workflow
KW - ISCHEMIC-STROKE
KW - MECHANICAL THROMBECTOMY
KW - REPERFUSION
KW - THERAPY
U2 - 10.1159/000508898
DO - 10.1159/000508898
M3 - Article
C2 - 32615562
SN - 1015-9770
VL - 49
SP - 321
EP - 327
JO - Cerebrovascular Diseases
JF - Cerebrovascular Diseases
IS - 3
ER -