Association of intravenous thrombolysis and pre-interventional reperfusion: a post hoc analysis of the SWIFT DIRECT trial
Copyright policy )Association of intravenous thrombolysis and pre-interventional reperfusion: a post hoc analysis of the SWIFT DIRECT trial
BackgroundA potential benefit of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) is pre-interventional reperfusion. Currently, there are few data on the occurrence of pre-interventional reperfusion in patients randomized to IVT or no IVT before MT.MethodsSWIFT DIRECT (Solitaire With the Intention For Thrombectomy Plus Intravenous t-PA vs DIRECT Solitaire Stent-retriever Thrombectomy in Acute Anterior Circulation Stroke) was a randomized controlled trial including acute ischemic stroke IVT eligible patients being directly admitted to a comprehensive stroke center, with allocation to IVT with MT versus MT alone. The primary endpoint of this analysis was the occurrence of pre-interventional reperfusion, defined as a pre-interventional expanded Thrombolysis in Cerebral Infarction score of ≥2a. The effect of IVT and potential treatment effect heterogeneity were analyzed using logistic regression analyses.ResultsOf 396 patients, pre-interventional reperfusion occurred in 20 (10.0%) patients randomized to IVT with MT, and in 7 (3.6%) patients randomized to MT alone. Receiving IVT favored the occurrence of pre-interventional reperfusion (adjusted OR 2.91, 95% CI 1.23 to 6.87). There was no IVT treatment effect heterogeneity on the occurrence of pre-interventional reperfusion with different strata of Randomization-to-Groin-Puncture time (p for interaction=0.33), although the effect tended to be stronger in patients with a Randomization-to-Groin-Puncture time >28 min (adjusted OR 4.65, 95% CI 1.16 to 18.68). There were no significant differences in rates of functional outcomes between patients with and without pre-interventional reperfusion.ConclusionEven for patients with proximal large vessel occlusions and direct access to MT, IVT resulted in an absolute increase of 6% in rates of pre-interventional reperfusion. The influence of time strata on the occurrence of pre-interventional reperfusion should be studied further in an individual patient data meta-analysis of comparable trials.Trial registration numberclinicaltrials.govNCT03192332.
- University of California, Los Angeles United States
- Universitätsmedizin Göttingen Germany
- Helsinki University Hospital Finland
- University of California at Los Angeles United States
- Centre Hospitalier Universitaire de Nancy France
MESH: Thrombolytic Therapy / methods, Mechanical Thrombolysis, [SDV]Life Sciences [q-bio], Surgery, anesthesiology, intensive care, radiology, 610, MESH: Fibrinolytic Agents / therapeutic use, 610 Medicine & health, MESH: Thrombectomy / methods, Brain Ischemia, Vasos sanguinis - Cirurgia, MESH: Brain Ischemia* / surgery, Fibrinolytic Agents, 616, DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Stroke, MESH: Brain Ischemia* / drug therapy, Humans, Thrombolytic Therapy, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::trombólisis mecánica, MESH: Treatment Outcome, Ischemic Stroke, Thrombectomy, Randomized Controlled Trials as Topic, MESH: Humans, Neurosciences, MESH: Mechanical Thrombolysis* / methods, Thrombolysis, MESH: Reperfusion, MESH: Stroke* / diagnostic imaging, Stroke, MESH: Brain Ischemia* / diagnostic imaging, MESH: Randomized Controlled Trials as Topic, ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::accidente cerebrovascular, Treatment Outcome, MESH: Ischemic Stroke* / etiology, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Thrombectomy, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Mechanical Thrombolysis, Reperfusion, Malalties cerebrovasculars - Cirurgia, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos vasculares::trombectomía, Teràpia trombolítica, MESH: Stroke* / surgery, MESH: Stroke* / drug therapy
MESH: Thrombolytic Therapy / methods, Mechanical Thrombolysis, [SDV]Life Sciences [q-bio], Surgery, anesthesiology, intensive care, radiology, 610, MESH: Fibrinolytic Agents / therapeutic use, 610 Medicine & health, MESH: Thrombectomy / methods, Brain Ischemia, Vasos sanguinis - Cirurgia, MESH: Brain Ischemia* / surgery, Fibrinolytic Agents, 616, DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Stroke, MESH: Brain Ischemia* / drug therapy, Humans, Thrombolytic Therapy, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::trombólisis mecánica, MESH: Treatment Outcome, Ischemic Stroke, Thrombectomy, Randomized Controlled Trials as Topic, MESH: Humans, Neurosciences, MESH: Mechanical Thrombolysis* / methods, Thrombolysis, MESH: Reperfusion, MESH: Stroke* / diagnostic imaging, Stroke, MESH: Brain Ischemia* / diagnostic imaging, MESH: Randomized Controlled Trials as Topic, ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::accidente cerebrovascular, Treatment Outcome, MESH: Ischemic Stroke* / etiology, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Thrombectomy, ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Mechanical Thrombolysis, Reperfusion, Malalties cerebrovasculars - Cirurgia, TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos vasculares::trombectomía, Teràpia trombolítica, MESH: Stroke* / surgery, MESH: Stroke* / drug therapy
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