دورية أكاديمية
أعرض في EDS

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

التفاصيل البيبلوغرافية
العنوان: Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone.
المؤلفون: van Kranendonk KR; Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands k.r.vankranendonk@amsterdamumc.nl., Kappelhof M; Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands., Bruggeman AAE; Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands., Rinkel LA; Neurology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands., Treurniet KM; Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands.; Radiology, Haaglanden Medical Center Bronovo, Den Haag, Zuid-Holland, The Netherlands., LeCouffe N; Neurology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands., Emmer BJ; Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands., Coutinho JM; Neurology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands., Wolff L; Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands., van Zwam WH; Radiology, Maastricht University Cardiovascular Research Institute Maastricht, Maastricht, Limburg, The Netherlands., van Oostenbrugge RJ; Neurology, Maastricht University Cardiovascular Research Institute Maastricht, Maastricht, Limburg, The Netherlands., van der Lugt A; Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands., Dippel DWJ; Neurology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands., Roos YBWEM; Neurology, Amsterdam UMC Locatie AMC, Amsterdam, North Holland, The Netherlands., Marquering HA; Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands.; Biomedical Engineering and Physics, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands., Majoie CBLM; Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, Noord-Holland, The Netherlands.
مؤلفون مشاركون: MR CLEAN-NO IV Investigators
المصدر: Journal of neurointerventional surgery [J Neurointerv Surg] 2023 Nov; Vol. 15 (e2), pp. e262-e269. Date of Electronic Publication: 2022 Nov 17.
نوع المنشور: Randomized Controlled Trial; Multicenter Study; Journal Article
اللغة: English
بيانات الدورية: Publisher: BMJ Publishing Group Country of Publication: England NLM ID: 101517079 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1759-8486 (Electronic) Linking ISSN: 17598478 NLM ISO Abbreviation: J Neurointerv Surg Subsets: MEDLINE
أسماء مطبوعة: Original Publication: London : BMJ Publishing Group, c2009-
مواضيع طبية MeSH: Ischemic Stroke*/etiology , Brain Ischemia*/diagnostic imaging , Brain Ischemia*/drug therapy , Brain Ischemia*/surgery , Stroke*/diagnostic imaging , Stroke*/drug therapy , Stroke*/surgery , Endovascular Procedures*/adverse effects, Humans ; Tissue Plasminogen Activator ; Fibrinolytic Agents/adverse effects ; Thrombolytic Therapy/adverse effects ; Treatment Outcome ; Thrombectomy/adverse effects ; Intracranial Hemorrhages/etiology ; Cerebral Infarction/etiology
مستخلص: 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.
Competing Interests: Competing interests: CBLM reports grants from CVON/Dutch Heart Foundation and Stryker (related and paid to institution), and TWIN Foundation, European Commission, Health Evaluation Netherlands (outside the submitted work and paid to institution); and is shareholder of Nico.lab. HAM is cofounder and shareholder of Nico.lab. DWJD and Van der Lugt report grants from Dutch Heart Foundation, Dutch Brain Foundation, Health Holland, Stryker, Medtronic Penumbra, Cerenovus and Thrombolytic Science Inc, all paid to the institution. YDWR is shareholder of Nico.lab. JMC reports research support from Medtronic (paid to institution). All other authors have nothing to disclose.
(© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)
فهرسة مساهمة: Investigator: Y Roos; C Majoie; K Treurniet; J Coutinho; B Emmer; N LeCouffe; M Kappelhof; L Rinkel; A Bruggeman; B Roozenbeek; AV Es; I Ridder; WV Zwam; BV Worp; R Lo; K Keizer; R Gons; L Yo; J Boiten; IVD Wijngaard; GL LycklamaNijeholt; G Lycklama; J Hofmeijer; J Martens; W Schonewille; JA Vos; A Tuladhar; F Schreuder; J Boogaarts; S Jenniskens; K Laat; LV Dijk; HD Hertog; BV Hasselt; P Brouwers; E Sturm; T Bulut; M Remmers; AV Norden; T Jong; A Rozeman; O Elgersma; M Uyttenboogaart; R Bokkers; JV Tuijl; I Boukrab; H Kortman; V Costalat; C Arquizan; R Lemmens; J Demeestere; P Desfontaines; D Brisbois; F Clarençon; Y Samson; M Brown; P White; J Gregson; D Nieboer; D Dippel; RV Nuland; AV Lugt; L Jacobi; RVD Berg; L Beenen; PV Doormaal; A Yoo; B Hammer; S Roosendaal; A Meijer; M Krietemeijer; AV Hoorn; D Gerrits; RV Oostenbrugge; SM Ben Jansen; H Kerkhof; P Koudstaal; H Lingsma; V Chalos; O Berkhemer; A Versteeg; L Wolff; J Su; M Tolhuisen; HV Voorst; HT Cate; M Maat; S Donse-Donkel; HV Beusekom; A Taha; SVD Berg; RV Graaf; RJ Goldhoorn; W Hinsenveld; A Pirson; L Sondag; R Reinink; J Brouwer; S Collette; WV Steen; R Sprengers; M Sterrenberg; NE Ghannouti; S Verheesen; W Pellikaan; K Blauwendraat; Y Drabbe; J Meris; M Simons; H Bongenaar; AV Loon; E Ponjee; R Eilander; S Kooij; M Jong; E Santegoets; S Roodenburg; AV Ahee; M Moynier; A Devroye; E Marcis; I Iezzi; A David; A Talbi; L Heiligers; Y Martens
Keywords: Hemorrhage; Stroke; Thrombectomy; Thrombolysis
المشرفين على المادة: EC 3.4.21.68 (Tissue Plasminogen Activator)
0 (Fibrinolytic Agents)
تواريخ الأحداث: Date Created: 20221117 Date Completed: 20231106 Latest Revision: 20231106
رمز التحديث: 20231106
DOI: 10.1136/jnis-2022-019569
PMID: 36396434
قاعدة البيانات: MEDLINE
الوصف
تدمد:1759-8486
DOI:10.1136/jnis-2022-019569