Impact of intravenous alteplase on sub-angiographic emboli in high-resolution diffusion-weighted imaging following successful thrombectomy
Objective Thrombus microfragmentation causing peripheral emboli (PE) during mechanical thrombectomy (MT) may modulate treatment effects, even in cases with successful reperfusion. This study aims to investigate whether intravenous alteplase is of potential benefit in reducing PE after successful MT....
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| Veröffentlicht in: | European radiology 2021-11, Vol.31 (11), p.8228-8235 |
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| creator | Broocks, Gabriel Meyer, Lukas Kabiri, Reza Kniep, Helge C. McDonough, Rosalie Bechstein, Matthias van Horn, Noel Lindner, Thomas Sedlacik, Jan Cheng, Bastian Thomalla, Götz Schön, Gerhard Fiehler, Jens Hanning, Uta Schönfeld, Michael H. |
| description | Objective
Thrombus microfragmentation causing peripheral emboli (PE) during mechanical thrombectomy (MT) may modulate treatment effects, even in cases with successful reperfusion. This study aims to investigate whether intravenous alteplase is of potential benefit in reducing PE after successful MT.
Methods
Patients from a prospective study treated at a tertiary care stroke center between 08/2017 and 12/2019 were analyzed. The main inclusion criterion was successful reperfusion after MT (defined as expanded thrombolysis in cerebral infarction (eTICI) scale ≥ 2b50) of large vessel occlusion anterior circulation stroke. All patients received a high-resolution diffusion-weighted imaging (DWI) follow-up 24 h after MT for PE detection. Patients were grouped as “direct MT” (no alteplase) or as MT plus additional intravenous alteplase. The number and volume of ischemic core lesions and PE were then quantified and analyzed.
Results
Fifty-six patients were prospectively enrolled. Additional intravenous alteplase was administered in 46.3% (26/56). There were no statistically significant differences of PE compared by groups of direct MT and additional intravenous alteplase administration regarding mean numbers (12.1, 95% CI 8.6–15.5 vs. 11.1, 95% CI 7.0–15.1;
p
= 0.701), and median volume (0.70 mL, IQR 0.21–1.55 vs. 0.39 mL, IQR 0.10–1.62;
p
= 0.554). In uni- and multivariable linear regression analysis, higher eTICI scores were significantly associated with reduced PE, while the administration of alteplase was neither associated with numbers nor volume of peripheral emboli. Additional alteplase did not alter reperfusion success.
Conclusions
Intravenous alteplase neither affects the number nor volume of sub-angiographic DWI-PE after successful endovascular reperfusion. In the light of currently running randomized trials, further studies are warranted to validate these findings.
Key Points
• Thrombus microfragmentation during endovascular stroke treatment may cause peripheral emboli that are only detectable on diffusion-weighted imaging and may directly compromise treatment effects.
• In this prospective study, the application of intravenous alteplase did not influence the occurrence of peripheral emboli detected on high-resolution diffusion-weighted imaging.
• A higher degree of recanalization was associated with a reduced number and volume of peripheral emboli and better functional outcome, while contrariwise, peripheral emboli did not modify the effect of recanaliz |
| doi_str_mv | 10.1007/s00330-021-07980-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8523452</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2524357036</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-58226059284d3f4fd043f11f78452846cfe1299a381d368b6176ab022a23030e3</originalsourceid><addsrcrecordid>eNp9kctu1TAQhi0EoqeFF2CBLLFhYxhfktgbJFRxqVSJDawtx7ETV058sJNWfQWeuj6cUi4LVh55vvnn8iP0gsIbCtC9LQCcAwFGCXRK1ugR2lHBGaEgxWO0A8Ul6ZQSJ-i0lCsAUFR0T9EJ56rlitId-nEx741dcfI4LGs2125JW8Emrm4fTXE4LbhsPTHLGNKYzX4KFru5TzHUAjyFcSLZlRS3NVR0CN5vpUbkxtXU6gYcZjOGZcQ-xZhuDlHZrHWl-C3idcpp7p1d03z7DD3xJhb3_P49Q98-fvh6_plcfvl0cf7-kljRiZU0krEWGsWkGLgXfgDBPaW-k6Kpf631jjKlDJd04K3sW9q1pgfGDOPAwfEz9O6ou9_62Q3WHfaOep_rpPlWJxP035klTHpM11o2jNceVeD1vUBO3zdXVj2HYl2MZnH1eJo1TPCmA95W9NU_6FXa8lLXq5RkUrG2kZViR8rmVEp2_mEYCvpgtT5aravV-qfVGmrRyz_XeCj55W0F-BEoNbWMLv_u_R_ZOw98t3A</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2582892658</pqid></control><display><type>article</type><title>Impact of intravenous alteplase on sub-angiographic emboli in high-resolution diffusion-weighted imaging following successful thrombectomy</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Broocks, Gabriel ; Meyer, Lukas ; Kabiri, Reza ; Kniep, Helge C. ; McDonough, Rosalie ; Bechstein, Matthias ; van Horn, Noel ; Lindner, Thomas ; Sedlacik, Jan ; Cheng, Bastian ; Thomalla, Götz ; Schön, Gerhard ; Fiehler, Jens ; Hanning, Uta ; Schönfeld, Michael H.</creator><creatorcontrib>Broocks, Gabriel ; Meyer, Lukas ; Kabiri, Reza ; Kniep, Helge C. ; McDonough, Rosalie ; Bechstein, Matthias ; van Horn, Noel ; Lindner, Thomas ; Sedlacik, Jan ; Cheng, Bastian ; Thomalla, Götz ; Schön, Gerhard ; Fiehler, Jens ; Hanning, Uta ; Schönfeld, Michael H.</creatorcontrib><description>Objective
Thrombus microfragmentation causing peripheral emboli (PE) during mechanical thrombectomy (MT) may modulate treatment effects, even in cases with successful reperfusion. This study aims to investigate whether intravenous alteplase is of potential benefit in reducing PE after successful MT.
Methods
Patients from a prospective study treated at a tertiary care stroke center between 08/2017 and 12/2019 were analyzed. The main inclusion criterion was successful reperfusion after MT (defined as expanded thrombolysis in cerebral infarction (eTICI) scale ≥ 2b50) of large vessel occlusion anterior circulation stroke. All patients received a high-resolution diffusion-weighted imaging (DWI) follow-up 24 h after MT for PE detection. Patients were grouped as “direct MT” (no alteplase) or as MT plus additional intravenous alteplase. The number and volume of ischemic core lesions and PE were then quantified and analyzed.
Results
Fifty-six patients were prospectively enrolled. Additional intravenous alteplase was administered in 46.3% (26/56). There were no statistically significant differences of PE compared by groups of direct MT and additional intravenous alteplase administration regarding mean numbers (12.1, 95% CI 8.6–15.5 vs. 11.1, 95% CI 7.0–15.1;
p
= 0.701), and median volume (0.70 mL, IQR 0.21–1.55 vs. 0.39 mL, IQR 0.10–1.62;
p
= 0.554). In uni- and multivariable linear regression analysis, higher eTICI scores were significantly associated with reduced PE, while the administration of alteplase was neither associated with numbers nor volume of peripheral emboli. Additional alteplase did not alter reperfusion success.
Conclusions
Intravenous alteplase neither affects the number nor volume of sub-angiographic DWI-PE after successful endovascular reperfusion. In the light of currently running randomized trials, further studies are warranted to validate these findings.
Key Points
• Thrombus microfragmentation during endovascular stroke treatment may cause peripheral emboli that are only detectable on diffusion-weighted imaging and may directly compromise treatment effects.
• In this prospective study, the application of intravenous alteplase did not influence the occurrence of peripheral emboli detected on high-resolution diffusion-weighted imaging.
• A higher degree of recanalization was associated with a reduced number and volume of peripheral emboli and better functional outcome, while contrariwise, peripheral emboli did not modify the effect of recanalization on modified Rankin Scale scores at day 90.</description><identifier>ISSN: 0938-7994</identifier><identifier>ISSN: 1432-1084</identifier><identifier>EISSN: 1432-1084</identifier><identifier>DOI: 10.1007/s00330-021-07980-0</identifier><identifier>PMID: 33963911</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Blood clots ; Brain Ischemia - complications ; Brain Ischemia - diagnostic imaging ; Brain Ischemia - drug therapy ; Cardiovascular system ; Cerebral blood flow ; Cerebral infarction ; Clinical trials ; Diagnostic Radiology ; Diffusion ; High resolution ; Humans ; Image resolution ; Imaging ; Internal Medicine ; Interventional Radiology ; Intravenous administration ; Ischemia ; Medicine ; Medicine & Public Health ; Neuro ; Neuroradiology ; Occlusion ; Patients ; Prospective Studies ; Radiology ; Regression analysis ; Reperfusion ; Statistical analysis ; Stroke ; Stroke - diagnostic imaging ; Thrombectomy ; Thrombolysis ; Thrombosis ; Tissue Plasminogen Activator ; Treatment Outcome ; Ultrasound</subject><ispartof>European radiology, 2021-11, Vol.31 (11), p.8228-8235</ispartof><rights>The Author(s) 2021</rights><rights>2021. The Author(s).</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-58226059284d3f4fd043f11f78452846cfe1299a381d368b6176ab022a23030e3</citedby><cites>FETCH-LOGICAL-c474t-58226059284d3f4fd043f11f78452846cfe1299a381d368b6176ab022a23030e3</cites><orcidid>0000-0002-7575-9850</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00330-021-07980-0$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00330-021-07980-0$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33963911$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Broocks, Gabriel</creatorcontrib><creatorcontrib>Meyer, Lukas</creatorcontrib><creatorcontrib>Kabiri, Reza</creatorcontrib><creatorcontrib>Kniep, Helge C.</creatorcontrib><creatorcontrib>McDonough, Rosalie</creatorcontrib><creatorcontrib>Bechstein, Matthias</creatorcontrib><creatorcontrib>van Horn, Noel</creatorcontrib><creatorcontrib>Lindner, Thomas</creatorcontrib><creatorcontrib>Sedlacik, Jan</creatorcontrib><creatorcontrib>Cheng, Bastian</creatorcontrib><creatorcontrib>Thomalla, Götz</creatorcontrib><creatorcontrib>Schön, Gerhard</creatorcontrib><creatorcontrib>Fiehler, Jens</creatorcontrib><creatorcontrib>Hanning, Uta</creatorcontrib><creatorcontrib>Schönfeld, Michael H.</creatorcontrib><title>Impact of intravenous alteplase on sub-angiographic emboli in high-resolution diffusion-weighted imaging following successful thrombectomy</title><title>European radiology</title><addtitle>Eur Radiol</addtitle><addtitle>Eur Radiol</addtitle><description>Objective
Thrombus microfragmentation causing peripheral emboli (PE) during mechanical thrombectomy (MT) may modulate treatment effects, even in cases with successful reperfusion. This study aims to investigate whether intravenous alteplase is of potential benefit in reducing PE after successful MT.
Methods
Patients from a prospective study treated at a tertiary care stroke center between 08/2017 and 12/2019 were analyzed. The main inclusion criterion was successful reperfusion after MT (defined as expanded thrombolysis in cerebral infarction (eTICI) scale ≥ 2b50) of large vessel occlusion anterior circulation stroke. All patients received a high-resolution diffusion-weighted imaging (DWI) follow-up 24 h after MT for PE detection. Patients were grouped as “direct MT” (no alteplase) or as MT plus additional intravenous alteplase. The number and volume of ischemic core lesions and PE were then quantified and analyzed.
Results
Fifty-six patients were prospectively enrolled. Additional intravenous alteplase was administered in 46.3% (26/56). There were no statistically significant differences of PE compared by groups of direct MT and additional intravenous alteplase administration regarding mean numbers (12.1, 95% CI 8.6–15.5 vs. 11.1, 95% CI 7.0–15.1;
p
= 0.701), and median volume (0.70 mL, IQR 0.21–1.55 vs. 0.39 mL, IQR 0.10–1.62;
p
= 0.554). In uni- and multivariable linear regression analysis, higher eTICI scores were significantly associated with reduced PE, while the administration of alteplase was neither associated with numbers nor volume of peripheral emboli. Additional alteplase did not alter reperfusion success.
Conclusions
Intravenous alteplase neither affects the number nor volume of sub-angiographic DWI-PE after successful endovascular reperfusion. In the light of currently running randomized trials, further studies are warranted to validate these findings.
Key Points
• Thrombus microfragmentation during endovascular stroke treatment may cause peripheral emboli that are only detectable on diffusion-weighted imaging and may directly compromise treatment effects.
• In this prospective study, the application of intravenous alteplase did not influence the occurrence of peripheral emboli detected on high-resolution diffusion-weighted imaging.
• A higher degree of recanalization was associated with a reduced number and volume of peripheral emboli and better functional outcome, while contrariwise, peripheral emboli did not modify the effect of recanalization on modified Rankin Scale scores at day 90.</description><subject>Blood clots</subject><subject>Brain Ischemia - complications</subject><subject>Brain Ischemia - diagnostic imaging</subject><subject>Brain Ischemia - drug therapy</subject><subject>Cardiovascular system</subject><subject>Cerebral blood flow</subject><subject>Cerebral infarction</subject><subject>Clinical trials</subject><subject>Diagnostic Radiology</subject><subject>Diffusion</subject><subject>High resolution</subject><subject>Humans</subject><subject>Image resolution</subject><subject>Imaging</subject><subject>Internal Medicine</subject><subject>Interventional Radiology</subject><subject>Intravenous administration</subject><subject>Ischemia</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neuro</subject><subject>Neuroradiology</subject><subject>Occlusion</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Radiology</subject><subject>Regression analysis</subject><subject>Reperfusion</subject><subject>Statistical analysis</subject><subject>Stroke</subject><subject>Stroke - diagnostic imaging</subject><subject>Thrombectomy</subject><subject>Thrombolysis</subject><subject>Thrombosis</subject><subject>Tissue Plasminogen Activator</subject><subject>Treatment Outcome</subject><subject>Ultrasound</subject><issn>0938-7994</issn><issn>1432-1084</issn><issn>1432-1084</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNp9kctu1TAQhi0EoqeFF2CBLLFhYxhfktgbJFRxqVSJDawtx7ETV058sJNWfQWeuj6cUi4LVh55vvnn8iP0gsIbCtC9LQCcAwFGCXRK1ugR2lHBGaEgxWO0A8Ul6ZQSJ-i0lCsAUFR0T9EJ56rlitId-nEx741dcfI4LGs2125JW8Emrm4fTXE4LbhsPTHLGNKYzX4KFru5TzHUAjyFcSLZlRS3NVR0CN5vpUbkxtXU6gYcZjOGZcQ-xZhuDlHZrHWl-C3idcpp7p1d03z7DD3xJhb3_P49Q98-fvh6_plcfvl0cf7-kljRiZU0krEWGsWkGLgXfgDBPaW-k6Kpf631jjKlDJd04K3sW9q1pgfGDOPAwfEz9O6ou9_62Q3WHfaOep_rpPlWJxP035klTHpM11o2jNceVeD1vUBO3zdXVj2HYl2MZnH1eJo1TPCmA95W9NU_6FXa8lLXq5RkUrG2kZViR8rmVEp2_mEYCvpgtT5aravV-qfVGmrRyz_XeCj55W0F-BEoNbWMLv_u_R_ZOw98t3A</recordid><startdate>20211101</startdate><enddate>20211101</enddate><creator>Broocks, Gabriel</creator><creator>Meyer, Lukas</creator><creator>Kabiri, Reza</creator><creator>Kniep, Helge C.</creator><creator>McDonough, Rosalie</creator><creator>Bechstein, Matthias</creator><creator>van Horn, Noel</creator><creator>Lindner, Thomas</creator><creator>Sedlacik, Jan</creator><creator>Cheng, Bastian</creator><creator>Thomalla, Götz</creator><creator>Schön, Gerhard</creator><creator>Fiehler, Jens</creator><creator>Hanning, Uta</creator><creator>Schönfeld, Michael H.</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><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>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-7575-9850</orcidid></search><sort><creationdate>20211101</creationdate><title>Impact of intravenous alteplase on sub-angiographic emboli in high-resolution diffusion-weighted imaging following successful thrombectomy</title><author>Broocks, Gabriel ; Meyer, Lukas ; Kabiri, Reza ; Kniep, Helge C. ; McDonough, Rosalie ; Bechstein, Matthias ; van Horn, Noel ; Lindner, Thomas ; Sedlacik, Jan ; Cheng, Bastian ; Thomalla, Götz ; Schön, Gerhard ; Fiehler, Jens ; Hanning, Uta ; Schönfeld, Michael H.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-58226059284d3f4fd043f11f78452846cfe1299a381d368b6176ab022a23030e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Blood clots</topic><topic>Brain Ischemia - complications</topic><topic>Brain Ischemia - diagnostic imaging</topic><topic>Brain Ischemia - drug therapy</topic><topic>Cardiovascular system</topic><topic>Cerebral blood flow</topic><topic>Cerebral infarction</topic><topic>Clinical trials</topic><topic>Diagnostic Radiology</topic><topic>Diffusion</topic><topic>High resolution</topic><topic>Humans</topic><topic>Image resolution</topic><topic>Imaging</topic><topic>Internal Medicine</topic><topic>Interventional Radiology</topic><topic>Intravenous administration</topic><topic>Ischemia</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neuro</topic><topic>Neuroradiology</topic><topic>Occlusion</topic><topic>Patients</topic><topic>Prospective Studies</topic><topic>Radiology</topic><topic>Regression analysis</topic><topic>Reperfusion</topic><topic>Statistical analysis</topic><topic>Stroke</topic><topic>Stroke - diagnostic imaging</topic><topic>Thrombectomy</topic><topic>Thrombolysis</topic><topic>Thrombosis</topic><topic>Tissue Plasminogen Activator</topic><topic>Treatment Outcome</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Broocks, Gabriel</creatorcontrib><creatorcontrib>Meyer, Lukas</creatorcontrib><creatorcontrib>Kabiri, Reza</creatorcontrib><creatorcontrib>Kniep, Helge C.</creatorcontrib><creatorcontrib>McDonough, Rosalie</creatorcontrib><creatorcontrib>Bechstein, Matthias</creatorcontrib><creatorcontrib>van Horn, Noel</creatorcontrib><creatorcontrib>Lindner, Thomas</creatorcontrib><creatorcontrib>Sedlacik, Jan</creatorcontrib><creatorcontrib>Cheng, Bastian</creatorcontrib><creatorcontrib>Thomalla, Götz</creatorcontrib><creatorcontrib>Schön, Gerhard</creatorcontrib><creatorcontrib>Fiehler, Jens</creatorcontrib><creatorcontrib>Hanning, Uta</creatorcontrib><creatorcontrib>Schönfeld, Michael H.</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>European radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Broocks, Gabriel</au><au>Meyer, Lukas</au><au>Kabiri, Reza</au><au>Kniep, Helge C.</au><au>McDonough, Rosalie</au><au>Bechstein, Matthias</au><au>van Horn, Noel</au><au>Lindner, Thomas</au><au>Sedlacik, Jan</au><au>Cheng, Bastian</au><au>Thomalla, Götz</au><au>Schön, Gerhard</au><au>Fiehler, Jens</au><au>Hanning, Uta</au><au>Schönfeld, Michael H.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of intravenous alteplase on sub-angiographic emboli in high-resolution diffusion-weighted imaging following successful thrombectomy</atitle><jtitle>European radiology</jtitle><stitle>Eur Radiol</stitle><addtitle>Eur Radiol</addtitle><date>2021-11-01</date><risdate>2021</risdate><volume>31</volume><issue>11</issue><spage>8228</spage><epage>8235</epage><pages>8228-8235</pages><issn>0938-7994</issn><issn>1432-1084</issn><eissn>1432-1084</eissn><abstract>Objective
Thrombus microfragmentation causing peripheral emboli (PE) during mechanical thrombectomy (MT) may modulate treatment effects, even in cases with successful reperfusion. This study aims to investigate whether intravenous alteplase is of potential benefit in reducing PE after successful MT.
Methods
Patients from a prospective study treated at a tertiary care stroke center between 08/2017 and 12/2019 were analyzed. The main inclusion criterion was successful reperfusion after MT (defined as expanded thrombolysis in cerebral infarction (eTICI) scale ≥ 2b50) of large vessel occlusion anterior circulation stroke. All patients received a high-resolution diffusion-weighted imaging (DWI) follow-up 24 h after MT for PE detection. Patients were grouped as “direct MT” (no alteplase) or as MT plus additional intravenous alteplase. The number and volume of ischemic core lesions and PE were then quantified and analyzed.
Results
Fifty-six patients were prospectively enrolled. Additional intravenous alteplase was administered in 46.3% (26/56). There were no statistically significant differences of PE compared by groups of direct MT and additional intravenous alteplase administration regarding mean numbers (12.1, 95% CI 8.6–15.5 vs. 11.1, 95% CI 7.0–15.1;
p
= 0.701), and median volume (0.70 mL, IQR 0.21–1.55 vs. 0.39 mL, IQR 0.10–1.62;
p
= 0.554). In uni- and multivariable linear regression analysis, higher eTICI scores were significantly associated with reduced PE, while the administration of alteplase was neither associated with numbers nor volume of peripheral emboli. Additional alteplase did not alter reperfusion success.
Conclusions
Intravenous alteplase neither affects the number nor volume of sub-angiographic DWI-PE after successful endovascular reperfusion. In the light of currently running randomized trials, further studies are warranted to validate these findings.
Key Points
• Thrombus microfragmentation during endovascular stroke treatment may cause peripheral emboli that are only detectable on diffusion-weighted imaging and may directly compromise treatment effects.
• In this prospective study, the application of intravenous alteplase did not influence the occurrence of peripheral emboli detected on high-resolution diffusion-weighted imaging.
• A higher degree of recanalization was associated with a reduced number and volume of peripheral emboli and better functional outcome, while contrariwise, peripheral emboli did not modify the effect of recanalization on modified Rankin Scale scores at day 90.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33963911</pmid><doi>10.1007/s00330-021-07980-0</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-7575-9850</orcidid><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8523452 |
| source | MEDLINE; SpringerNature Journals |
| subjects | Blood clots Brain Ischemia - complications Brain Ischemia - diagnostic imaging Brain Ischemia - drug therapy Cardiovascular system Cerebral blood flow Cerebral infarction Clinical trials Diagnostic Radiology Diffusion High resolution Humans Image resolution Imaging Internal Medicine Interventional Radiology Intravenous administration Ischemia Medicine Medicine & Public Health Neuro Neuroradiology Occlusion Patients Prospective Studies Radiology Regression analysis Reperfusion Statistical analysis Stroke Stroke - diagnostic imaging Thrombectomy Thrombolysis Thrombosis Tissue Plasminogen Activator Treatment Outcome Ultrasound |
| title | Impact of intravenous alteplase on sub-angiographic emboli in high-resolution diffusion-weighted imaging following successful thrombectomy |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-18T19%3A11%3A54IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Impact%20of%20intravenous%20alteplase%20on%20sub-angiographic%20emboli%20in%20high-resolution%20diffusion-weighted%20imaging%20following%20successful%20thrombectomy&rft.jtitle=European%20radiology&rft.au=Broocks,%20Gabriel&rft.date=2021-11-01&rft.volume=31&rft.issue=11&rft.spage=8228&rft.epage=8235&rft.pages=8228-8235&rft.issn=0938-7994&rft.eissn=1432-1084&rft_id=info:doi/10.1007/s00330-021-07980-0&rft_dat=%3Cproquest_pubme%3E2524357036%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2582892658&rft_id=info:pmid/33963911&rfr_iscdi=true |