Intraarterial thrombolytics as an adjunct to mechanical thrombectomy in patients with basilar artery occlusion
Background and Purpose There are limited data regarding safety and effectiveness of concurrent intraarterial thrombolytics as adjunct to mechanical thrombectomy in acute ischemic stroke patients with basilar artery occlusion. Methods We analyzed data from a prospective multicenter registry to assess...
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| Veröffentlicht in: | Journal of neuroimaging 2023-05, Vol.33 (3), p.415-421 |
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| creator | Qureshi, Adnan I. Lodhi, Abdullah Ma, Xiaoyu Tao, Chunrong Li, Rui Xu, Pengfei Hu, Wei |
| description | Background and Purpose
There are limited data regarding safety and effectiveness of concurrent intraarterial thrombolytics as adjunct to mechanical thrombectomy in acute ischemic stroke patients with basilar artery occlusion.
Methods
We analyzed data from a prospective multicenter registry to assess the independent effect of intraarterial thrombolysis on (1) favorable outcome (modified Rankin Scale 0‐3) at 90 days; (2) symptomatic intracranial hemorrhage (sICH) within 72 hours; and (3) death within 90 days post‐enrollment after adjustment for potential confounders.
Results
There was no difference in the adjusted odds of achieving favorable outcome at 90 days (odds ratio [OR] = 1.1, 95% confidence interval [CI]: 0.73‐1.68) in patients who received intraarterial thrombolysis (n = 126) compared with those who did not receive intraarterial thrombolysis (n = 1546) despite significantly higher use in patients with postprocedure modified Thrombolysis in Cerebral Infarction (mTICI) grade |
| doi_str_mv | 10.1111/jon.13089 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2811938430</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2811938430</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3539-f6c7258700f890421cf45f47925401cd660dc79829fc3f80a6488452c93633043</originalsourceid><addsrcrecordid>eNp10ctKAzEUBuAgiq3VhS8gATe6GM11JllK8VIputH1kKYZmjKT1CSDzNsb2-pCMBzIWXz5OeQAcI7RDc7ndu3dDaZIyAMwxpyTouSlPMw94rggRLAROIlxjRDBjNBjMKJlJSvEqjFwM5eCUiGZYFUL0yr4buHbIVkdocrloFque6cTTB52Rq-Us_pXGp18N0Dr4EYla1yK8NOmFVyoaFsV4DZ4gF7rto_Wu1Nw1Kg2mrP9PQHvD_dv06di_vo4m97NC005lUVT6opwUSHUCIkYwbphvGGVJJwhrJdliZa6koLIRtNGIFUyIRgnWtKSUsToBFztcjfBf_QmprqzUZu2Vc74PtZEYCypYBRlevmHrn0fXJ5uq_IUWIisrndKBx9jME29CbZTYagxqr-XkF-5eruEbC_2if2iM8tf-fPrGdzuwKdtzfB_Uv38-rKL_AJMcpCr</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2811587188</pqid></control><display><type>article</type><title>Intraarterial thrombolytics as an adjunct to mechanical thrombectomy in patients with basilar artery occlusion</title><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><creator>Qureshi, Adnan I. ; Lodhi, Abdullah ; Ma, Xiaoyu ; Tao, Chunrong ; Li, Rui ; Xu, Pengfei ; Hu, Wei</creator><creatorcontrib>Qureshi, Adnan I. ; Lodhi, Abdullah ; Ma, Xiaoyu ; Tao, Chunrong ; Li, Rui ; Xu, Pengfei ; Hu, Wei ; for Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) Registry Investigators ; for Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) Registry Investigators</creatorcontrib><description>Background and Purpose
There are limited data regarding safety and effectiveness of concurrent intraarterial thrombolytics as adjunct to mechanical thrombectomy in acute ischemic stroke patients with basilar artery occlusion.
Methods
We analyzed data from a prospective multicenter registry to assess the independent effect of intraarterial thrombolysis on (1) favorable outcome (modified Rankin Scale 0‐3) at 90 days; (2) symptomatic intracranial hemorrhage (sICH) within 72 hours; and (3) death within 90 days post‐enrollment after adjustment for potential confounders.
Results
There was no difference in the adjusted odds of achieving favorable outcome at 90 days (odds ratio [OR] = 1.1, 95% confidence interval [CI]: 0.73‐1.68) in patients who received intraarterial thrombolysis (n = 126) compared with those who did not receive intraarterial thrombolysis (n = 1546) despite significantly higher use in patients with postprocedure modified Thrombolysis in Cerebral Infarction (mTICI) grade <3. There were no differences in adjusted odds of sICH within 72 hours (OR = 0.8, 95% CI: 0.31‐2.08) or death within 90 days (OR = 0.91, 95% CI: 0.60‐1.37). In subgroup analyses, intraarterial thrombolysis was associated with (nonsignificantly) higher odds of achieving a favorable outcome at 90 days among patients aged between 65 and 80 years, those with National Institutes of Health Stroke Scale score <10, and those with postprocedure mTICI grade 2b.
Conclusions
Our analysis supported the safety of intraarterial thrombolysis as adjunct to mechanical thrombectomy in acute ischemic stroke patients with basilar artery occlusion. Identification of patient subgroups in whom intraarterial thrombolytics appeared to be more beneficial may assist in future clinical trial designs.</description><identifier>ISSN: 1051-2284</identifier><identifier>EISSN: 1552-6569</identifier><identifier>DOI: 10.1111/jon.13089</identifier><identifier>PMID: 36797047</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>acute ischemic stroke ; Aged ; Aged, 80 and over ; Arterial Occlusive Diseases - diagnostic imaging ; Arterial Occlusive Diseases - drug therapy ; Arterial Occlusive Diseases - surgery ; Basilar Artery - diagnostic imaging ; Basilar Artery - surgery ; basilar artery occlusion ; Cerebral blood flow ; Cerebral Infarction ; Endovascular Procedures - methods ; Fibrinolytic Agents - therapeutic use ; Hemorrhage ; Humans ; intraarterial thrombolysis ; Intracranial Hemorrhages ; intravenous thrombolysis ; Ischemia ; Ischemic Stroke - drug therapy ; Neuroimaging ; Occlusion ; Prospective Studies ; Safety ; Stroke ; Stroke - diagnostic imaging ; Stroke - drug therapy ; Stroke - surgery ; Subgroups ; thrombectomy ; Thrombectomy - methods ; Thrombolysis ; Treatment Outcome</subject><ispartof>Journal of neuroimaging, 2023-05, Vol.33 (3), p.415-421</ispartof><rights>2023 American Society of Neuroimaging.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3539-f6c7258700f890421cf45f47925401cd660dc79829fc3f80a6488452c93633043</citedby><cites>FETCH-LOGICAL-c3539-f6c7258700f890421cf45f47925401cd660dc79829fc3f80a6488452c93633043</cites><orcidid>0000-0003-4962-540X ; 0000-0002-8180-7855</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjon.13089$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjon.13089$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,778,782,1414,27911,27912,45561,45562</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36797047$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Qureshi, Adnan I.</creatorcontrib><creatorcontrib>Lodhi, Abdullah</creatorcontrib><creatorcontrib>Ma, Xiaoyu</creatorcontrib><creatorcontrib>Tao, Chunrong</creatorcontrib><creatorcontrib>Li, Rui</creatorcontrib><creatorcontrib>Xu, Pengfei</creatorcontrib><creatorcontrib>Hu, Wei</creatorcontrib><creatorcontrib>for Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) Registry Investigators</creatorcontrib><creatorcontrib>for Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) Registry Investigators</creatorcontrib><title>Intraarterial thrombolytics as an adjunct to mechanical thrombectomy in patients with basilar artery occlusion</title><title>Journal of neuroimaging</title><addtitle>J Neuroimaging</addtitle><description>Background and Purpose
There are limited data regarding safety and effectiveness of concurrent intraarterial thrombolytics as adjunct to mechanical thrombectomy in acute ischemic stroke patients with basilar artery occlusion.
Methods
We analyzed data from a prospective multicenter registry to assess the independent effect of intraarterial thrombolysis on (1) favorable outcome (modified Rankin Scale 0‐3) at 90 days; (2) symptomatic intracranial hemorrhage (sICH) within 72 hours; and (3) death within 90 days post‐enrollment after adjustment for potential confounders.
Results
There was no difference in the adjusted odds of achieving favorable outcome at 90 days (odds ratio [OR] = 1.1, 95% confidence interval [CI]: 0.73‐1.68) in patients who received intraarterial thrombolysis (n = 126) compared with those who did not receive intraarterial thrombolysis (n = 1546) despite significantly higher use in patients with postprocedure modified Thrombolysis in Cerebral Infarction (mTICI) grade <3. There were no differences in adjusted odds of sICH within 72 hours (OR = 0.8, 95% CI: 0.31‐2.08) or death within 90 days (OR = 0.91, 95% CI: 0.60‐1.37). In subgroup analyses, intraarterial thrombolysis was associated with (nonsignificantly) higher odds of achieving a favorable outcome at 90 days among patients aged between 65 and 80 years, those with National Institutes of Health Stroke Scale score <10, and those with postprocedure mTICI grade 2b.
Conclusions
Our analysis supported the safety of intraarterial thrombolysis as adjunct to mechanical thrombectomy in acute ischemic stroke patients with basilar artery occlusion. Identification of patient subgroups in whom intraarterial thrombolytics appeared to be more beneficial may assist in future clinical trial designs.</description><subject>acute ischemic stroke</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Arterial Occlusive Diseases - diagnostic imaging</subject><subject>Arterial Occlusive Diseases - drug therapy</subject><subject>Arterial Occlusive Diseases - surgery</subject><subject>Basilar Artery - diagnostic imaging</subject><subject>Basilar Artery - surgery</subject><subject>basilar artery occlusion</subject><subject>Cerebral blood flow</subject><subject>Cerebral Infarction</subject><subject>Endovascular Procedures - methods</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Hemorrhage</subject><subject>Humans</subject><subject>intraarterial thrombolysis</subject><subject>Intracranial Hemorrhages</subject><subject>intravenous thrombolysis</subject><subject>Ischemia</subject><subject>Ischemic Stroke - drug therapy</subject><subject>Neuroimaging</subject><subject>Occlusion</subject><subject>Prospective Studies</subject><subject>Safety</subject><subject>Stroke</subject><subject>Stroke - diagnostic imaging</subject><subject>Stroke - drug therapy</subject><subject>Stroke - surgery</subject><subject>Subgroups</subject><subject>thrombectomy</subject><subject>Thrombectomy - methods</subject><subject>Thrombolysis</subject><subject>Treatment Outcome</subject><issn>1051-2284</issn><issn>1552-6569</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10ctKAzEUBuAgiq3VhS8gATe6GM11JllK8VIputH1kKYZmjKT1CSDzNsb2-pCMBzIWXz5OeQAcI7RDc7ndu3dDaZIyAMwxpyTouSlPMw94rggRLAROIlxjRDBjNBjMKJlJSvEqjFwM5eCUiGZYFUL0yr4buHbIVkdocrloFque6cTTB52Rq-Us_pXGp18N0Dr4EYla1yK8NOmFVyoaFsV4DZ4gF7rto_Wu1Nw1Kg2mrP9PQHvD_dv06di_vo4m97NC005lUVT6opwUSHUCIkYwbphvGGVJJwhrJdliZa6koLIRtNGIFUyIRgnWtKSUsToBFztcjfBf_QmprqzUZu2Vc74PtZEYCypYBRlevmHrn0fXJ5uq_IUWIisrndKBx9jME29CbZTYagxqr-XkF-5eruEbC_2if2iM8tf-fPrGdzuwKdtzfB_Uv38-rKL_AJMcpCr</recordid><startdate>202305</startdate><enddate>202305</enddate><creator>Qureshi, Adnan I.</creator><creator>Lodhi, Abdullah</creator><creator>Ma, Xiaoyu</creator><creator>Tao, Chunrong</creator><creator>Li, Rui</creator><creator>Xu, Pengfei</creator><creator>Hu, Wei</creator><general>Wiley Subscription Services, Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7QP</scope><scope>7TK</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4962-540X</orcidid><orcidid>https://orcid.org/0000-0002-8180-7855</orcidid></search><sort><creationdate>202305</creationdate><title>Intraarterial thrombolytics as an adjunct to mechanical thrombectomy in patients with basilar artery occlusion</title><author>Qureshi, Adnan I. ; Lodhi, Abdullah ; Ma, Xiaoyu ; Tao, Chunrong ; Li, Rui ; Xu, Pengfei ; Hu, Wei</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3539-f6c7258700f890421cf45f47925401cd660dc79829fc3f80a6488452c93633043</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>acute ischemic stroke</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Arterial Occlusive Diseases - diagnostic imaging</topic><topic>Arterial Occlusive Diseases - drug therapy</topic><topic>Arterial Occlusive Diseases - surgery</topic><topic>Basilar Artery - diagnostic imaging</topic><topic>Basilar Artery - surgery</topic><topic>basilar artery occlusion</topic><topic>Cerebral blood flow</topic><topic>Cerebral Infarction</topic><topic>Endovascular Procedures - methods</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Hemorrhage</topic><topic>Humans</topic><topic>intraarterial thrombolysis</topic><topic>Intracranial Hemorrhages</topic><topic>intravenous thrombolysis</topic><topic>Ischemia</topic><topic>Ischemic Stroke - drug therapy</topic><topic>Neuroimaging</topic><topic>Occlusion</topic><topic>Prospective Studies</topic><topic>Safety</topic><topic>Stroke</topic><topic>Stroke - diagnostic imaging</topic><topic>Stroke - drug therapy</topic><topic>Stroke - surgery</topic><topic>Subgroups</topic><topic>thrombectomy</topic><topic>Thrombectomy - methods</topic><topic>Thrombolysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Qureshi, Adnan I.</creatorcontrib><creatorcontrib>Lodhi, Abdullah</creatorcontrib><creatorcontrib>Ma, Xiaoyu</creatorcontrib><creatorcontrib>Tao, Chunrong</creatorcontrib><creatorcontrib>Li, Rui</creatorcontrib><creatorcontrib>Xu, Pengfei</creatorcontrib><creatorcontrib>Hu, Wei</creatorcontrib><creatorcontrib>for Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) Registry Investigators</creatorcontrib><creatorcontrib>for Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) Registry Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neuroimaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Qureshi, Adnan I.</au><au>Lodhi, Abdullah</au><au>Ma, Xiaoyu</au><au>Tao, Chunrong</au><au>Li, Rui</au><au>Xu, Pengfei</au><au>Hu, Wei</au><aucorp>for Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) Registry Investigators</aucorp><aucorp>for Endovascular Treatment for Acute Basilar Artery Occlusion (ATTENTION) Registry Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intraarterial thrombolytics as an adjunct to mechanical thrombectomy in patients with basilar artery occlusion</atitle><jtitle>Journal of neuroimaging</jtitle><addtitle>J Neuroimaging</addtitle><date>2023-05</date><risdate>2023</risdate><volume>33</volume><issue>3</issue><spage>415</spage><epage>421</epage><pages>415-421</pages><issn>1051-2284</issn><eissn>1552-6569</eissn><abstract>Background and Purpose
There are limited data regarding safety and effectiveness of concurrent intraarterial thrombolytics as adjunct to mechanical thrombectomy in acute ischemic stroke patients with basilar artery occlusion.
Methods
We analyzed data from a prospective multicenter registry to assess the independent effect of intraarterial thrombolysis on (1) favorable outcome (modified Rankin Scale 0‐3) at 90 days; (2) symptomatic intracranial hemorrhage (sICH) within 72 hours; and (3) death within 90 days post‐enrollment after adjustment for potential confounders.
Results
There was no difference in the adjusted odds of achieving favorable outcome at 90 days (odds ratio [OR] = 1.1, 95% confidence interval [CI]: 0.73‐1.68) in patients who received intraarterial thrombolysis (n = 126) compared with those who did not receive intraarterial thrombolysis (n = 1546) despite significantly higher use in patients with postprocedure modified Thrombolysis in Cerebral Infarction (mTICI) grade <3. There were no differences in adjusted odds of sICH within 72 hours (OR = 0.8, 95% CI: 0.31‐2.08) or death within 90 days (OR = 0.91, 95% CI: 0.60‐1.37). In subgroup analyses, intraarterial thrombolysis was associated with (nonsignificantly) higher odds of achieving a favorable outcome at 90 days among patients aged between 65 and 80 years, those with National Institutes of Health Stroke Scale score <10, and those with postprocedure mTICI grade 2b.
Conclusions
Our analysis supported the safety of intraarterial thrombolysis as adjunct to mechanical thrombectomy in acute ischemic stroke patients with basilar artery occlusion. Identification of patient subgroups in whom intraarterial thrombolytics appeared to be more beneficial may assist in future clinical trial designs.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>36797047</pmid><doi>10.1111/jon.13089</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-4962-540X</orcidid><orcidid>https://orcid.org/0000-0002-8180-7855</orcidid></addata></record> |
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| subjects | acute ischemic stroke Aged Aged, 80 and over Arterial Occlusive Diseases - diagnostic imaging Arterial Occlusive Diseases - drug therapy Arterial Occlusive Diseases - surgery Basilar Artery - diagnostic imaging Basilar Artery - surgery basilar artery occlusion Cerebral blood flow Cerebral Infarction Endovascular Procedures - methods Fibrinolytic Agents - therapeutic use Hemorrhage Humans intraarterial thrombolysis Intracranial Hemorrhages intravenous thrombolysis Ischemia Ischemic Stroke - drug therapy Neuroimaging Occlusion Prospective Studies Safety Stroke Stroke - diagnostic imaging Stroke - drug therapy Stroke - surgery Subgroups thrombectomy Thrombectomy - methods Thrombolysis Treatment Outcome |
| title | Intraarterial thrombolytics as an adjunct to mechanical thrombectomy in patients with basilar artery occlusion |
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