Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy
Objective: To identify factors associated with early angiographic reperfusion improvement (EARI) following intra-arterial fibrinolytics (IAF) after failed or incomplete mechanical thrombectomy (MT). Methods: A subset of patients treated with MT and IAF rescue after incomplete reperfusion included in...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-06-01
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| Series: | Clinical and Translational Neuroscience |
| Online Access: | https://doi.org/10.1177/2514183X211017363 |
| _version_ | 1818737538063400960 |
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| author | Johannes Kaesmacher Giovanni Peschi Nuran Abdullayev Basel Maamari Tomas Dobrocky Jan Vynckier Eike Piechowiak Raoul Pop Daniel Behme Peter B Sporns Hanna Styczen Pekka Virtanen Lukas Meyer Thomas R Meinel Daniel Cantré Christoph Kabbasch Volker Maus Johanna Pekkola Sebastian Fischer Anca Hasiu Alexander Schwarz Moritz Wildgruber David J Seiffge Sönke Langner Nicolas Martinez-Majander Alexander Radbruch Marc Schlamann Dan Mihoc Rémy Beaujeux Daniel Strbian Jens Fiehler Pasquale Mordasini Jan Gralla Urs Fischer |
| author_facet | Johannes Kaesmacher Giovanni Peschi Nuran Abdullayev Basel Maamari Tomas Dobrocky Jan Vynckier Eike Piechowiak Raoul Pop Daniel Behme Peter B Sporns Hanna Styczen Pekka Virtanen Lukas Meyer Thomas R Meinel Daniel Cantré Christoph Kabbasch Volker Maus Johanna Pekkola Sebastian Fischer Anca Hasiu Alexander Schwarz Moritz Wildgruber David J Seiffge Sönke Langner Nicolas Martinez-Majander Alexander Radbruch Marc Schlamann Dan Mihoc Rémy Beaujeux Daniel Strbian Jens Fiehler Pasquale Mordasini Jan Gralla Urs Fischer |
| author_sort | Johannes Kaesmacher |
| collection | DOAJ |
| description | Objective: To identify factors associated with early angiographic reperfusion improvement (EARI) following intra-arterial fibrinolytics (IAF) after failed or incomplete mechanical thrombectomy (MT). Methods: A subset of patients treated with MT and IAF rescue after incomplete reperfusion included in the INFINITY (INtra-arterial FIbriNolytics In ThrombectomY) multicenter observational registry was analyzed. Multivariable logistic regression was used to identify factors associated with EARI. Heterogeneity of the clinical effect of EARI on functional independence (defined as modified Rankin Score ≤2) was tested with interaction terms. Results: A total of 228 patients (median age: 72 years, 44.1% female) received IAF as rescue for failed or incomplete MT and had a post-fibrinolytic angiographic control run available (50.9% EARI). A cardioembolic stroke origin (adjusted odds ratio (aOR) 3.72, 95% confidence interval (CI) 1.39–10.0) and shorter groin puncture to IAF intervals (aOR 0.82, 95% CI 0.71–0.95 per 15-min delay) were associated with EARI, while pre-interventional thrombolysis showed no association (aOR 1.15, 95% CI 0.59–2.26). The clinical benefit of EARI after IAF seemed more pronounced in patients without or only minor early ischemic changes (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥9, aOR 4.00, 95% CI 1.37–11.61) and was absent in patients with moderate to severe ischemic changes (ASPECTS ≤8, aOR 0.94, 95% CI 0.27–3.27, p for interaction: 0.095). Conclusion: Early rescue and a cardioembolic stroke origin were associated with more frequent EARI after IAF. The clinical effect of EARI seemed reduced in patients with already established infarcts. If confirmed, these findings can help to inform patient selection and inclusion criteria for randomized-controlled trials evaluating IAF as rescue after MT. |
| first_indexed | 2024-12-18T00:54:38Z |
| format | Article |
| id | doaj.art-4321ff1c9be34730839d41bb699eeab7 |
| institution | Directory Open Access Journal |
| issn | 2514-183X |
| language | English |
| last_indexed | 2024-12-18T00:54:38Z |
| publishDate | 2021-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Clinical and Translational Neuroscience |
| spelling | doaj.art-4321ff1c9be34730839d41bb699eeab72022-12-21T21:26:34ZengMDPI AGClinical and Translational Neuroscience2514-183X2021-06-01510.1177/2514183X211017363Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomyJohannes Kaesmacher0Giovanni Peschi1Nuran Abdullayev2Basel Maamari3Tomas Dobrocky4Jan Vynckier5Eike Piechowiak6Raoul Pop7Daniel Behme8Peter B Sporns9Hanna Styczen10Pekka Virtanen11Lukas Meyer12Thomas R Meinel13Daniel Cantré14Christoph Kabbasch15Volker Maus16Johanna Pekkola17Sebastian Fischer18Anca Hasiu19Alexander Schwarz20Moritz Wildgruber21David J Seiffge22Sönke Langner23Nicolas Martinez-Majander24Alexander Radbruch25Marc Schlamann26Dan Mihoc27Rémy Beaujeux28Daniel Strbian29Jens Fiehler30Pasquale Mordasini31Jan Gralla32Urs Fischer33 University Institute of Diagnostic and Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland University Institute of Diagnostic and Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland Department of Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France Department of Neuroradiology, University Hospital Göttingen, Göttingen, Germany. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Department of Neuroradiology, University Hospital Essen, Essen, Germany. Department of Neuroradiology, University Hospital Helsinki, Helsinki, Finland. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland Department of Radiology, University Hospital Rostock, Rostock, Germany Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany Department of Neuroradiology, Knappschaftskrankenhaus Bochum, Bochum, Germany. Department of Neuroradiology, University Hospital Helsinki, Helsinki, Finland. Department of Neuroradiology, Knappschaftskrankenhaus Bochum, Bochum, Germany. Department of Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France Department of Neuroradiology, University Hospital Göttingen, Göttingen, Germany. Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany. Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland Department of Radiology, University Hospital Rostock, Rostock, Germany Department of Neurology, University Hospital Helsinki, Helsinki, Finland. Department of Neuroradiology, University Hospital Bonn, Bonn, Germany. Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, Cologne, Germany Department of Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France Department of Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France Department of Neurology, University Hospital Helsinki, Helsinki, Finland. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland University Institute of Diagnostic and Interventional Neuroradiology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, SwitzerlandObjective: To identify factors associated with early angiographic reperfusion improvement (EARI) following intra-arterial fibrinolytics (IAF) after failed or incomplete mechanical thrombectomy (MT). Methods: A subset of patients treated with MT and IAF rescue after incomplete reperfusion included in the INFINITY (INtra-arterial FIbriNolytics In ThrombectomY) multicenter observational registry was analyzed. Multivariable logistic regression was used to identify factors associated with EARI. Heterogeneity of the clinical effect of EARI on functional independence (defined as modified Rankin Score ≤2) was tested with interaction terms. Results: A total of 228 patients (median age: 72 years, 44.1% female) received IAF as rescue for failed or incomplete MT and had a post-fibrinolytic angiographic control run available (50.9% EARI). A cardioembolic stroke origin (adjusted odds ratio (aOR) 3.72, 95% confidence interval (CI) 1.39–10.0) and shorter groin puncture to IAF intervals (aOR 0.82, 95% CI 0.71–0.95 per 15-min delay) were associated with EARI, while pre-interventional thrombolysis showed no association (aOR 1.15, 95% CI 0.59–2.26). The clinical benefit of EARI after IAF seemed more pronounced in patients without or only minor early ischemic changes (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥9, aOR 4.00, 95% CI 1.37–11.61) and was absent in patients with moderate to severe ischemic changes (ASPECTS ≤8, aOR 0.94, 95% CI 0.27–3.27, p for interaction: 0.095). Conclusion: Early rescue and a cardioembolic stroke origin were associated with more frequent EARI after IAF. The clinical effect of EARI seemed reduced in patients with already established infarcts. If confirmed, these findings can help to inform patient selection and inclusion criteria for randomized-controlled trials evaluating IAF as rescue after MT.https://doi.org/10.1177/2514183X211017363 |
| spellingShingle | Johannes Kaesmacher Giovanni Peschi Nuran Abdullayev Basel Maamari Tomas Dobrocky Jan Vynckier Eike Piechowiak Raoul Pop Daniel Behme Peter B Sporns Hanna Styczen Pekka Virtanen Lukas Meyer Thomas R Meinel Daniel Cantré Christoph Kabbasch Volker Maus Johanna Pekkola Sebastian Fischer Anca Hasiu Alexander Schwarz Moritz Wildgruber David J Seiffge Sönke Langner Nicolas Martinez-Majander Alexander Radbruch Marc Schlamann Dan Mihoc Rémy Beaujeux Daniel Strbian Jens Fiehler Pasquale Mordasini Jan Gralla Urs Fischer Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy Clinical and Translational Neuroscience |
| title | Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy |
| title_full | Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy |
| title_fullStr | Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy |
| title_full_unstemmed | Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy |
| title_short | Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy |
| title_sort | factors associated with early reperfusion improvement after intra arterial fibrinolytics as rescue for mechanical thrombectomy |
| url | https://doi.org/10.1177/2514183X211017363 |
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