Intravenous Thrombolysis Is Not Associated with Increased Time to Endovascular Treatment
| Autor: | Robert J. van Oostenbrugge, Geert J. Lycklama à Nijeholt, Jan Albert Vos, Wouter J. Schonewille, Inger R. de Ridder, Jelis Boiten, Clean Registry Investigators, Wouter H. Hinsenveld, Jonathan M. Coutinho, Wim H. van Zwam |
|---|---|
| Přispěvatelé: | Klinische Neurowetenschappen, MUMC+: MA Niet Med Staf Neurologie (9), RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Med Staf Spec Neurologie (9), MUMC+: MA Neurologie (3), MUMC+: Hersen en Zenuw Centrum (3), Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B06 Imaging, Neurology, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders |
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
Male
Time Factors medicine.medical_treatment 030204 cardiovascular system & hematology THERAPY Brain Ischemia Workflow 0302 clinical medicine Risk Factors Endovascular treatment of acute stroke Occlusion Clinical endpoint REPERFUSION Thrombolytic Therapy Registries Stroke Netherlands Aged 80 and over medicine.diagnostic_test Endovascular Procedures Thrombolysis Middle Aged medicine.anatomical_structure Treatment Outcome ISCHEMIC-STROKE Neurology Administration Intravenous Female Intravenous thrombolytic therapy of stroke Cardiology and Cardiovascular Medicine Intracranial Hemorrhages medicine.medical_specialty Time to treatment Risk Assessment Time-to-Treatment 03 medical and health sciences Fibrinolytic Agents medicine Humans Acute stroke intervention Endovascular treatment Aged Retrospective Studies Groin business.industry Stroke organization MECHANICAL THROMBECTOMY Digital subtraction angiography medicine.disease Surgery Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Cerebrovascular Diseases, 49(3), 321-327. Karger Cerebrovascular diseases (Basel, Switzerland), 49(3), 321-327. S. Karger AG |
| ISSN: | 1015-9770 |
| Popis: | Background: Endovascular treatment (EVT) with or without intravenous thrombolysis (IVT) is effective and safe in ischemic stroke caused by large vessel occlusion, but IVT might delay time to EVT or increase risk of intracranial hemorrhage (ICH). We assessed the influence of prior IVT on time to treatment and risk of ICH in patients treated with EVT. Methods: We analyzed data from the MR CLEAN Registry and included patients with an anterior circulation occlusion treated with EVT who presented directly to an intervention center, between 2014 and 2017. Primary endpoint was the door to groin time. Secondary outcomes were workflow time intervals and safety outcomes. We compared patients who received EVT only with patients who received IVT prior to EVT. Results: We included 1,427 patients directly referred to an intervention center of whom 1,023 (72%) received IVT + EVT. Adjusted door to CT imaging and door to groin time were shorter in IVT + EVT patients (difference 5.7 min [95% CI: 4.6–6.8] and 7.0 min [95% CI: 2.4–12], respectively) while CT imaging to groin time was similar between the groups. Early recanalization on digital subtraction angiography before EVT was seen more often after prior IVT (11 vs. 5.2%, aOR 2.4 [95% CI: 1.4–4.2]). Rates of symptomatic ICH were similar. Conclusion: Prior IVT did not delay door to groin times and was associated with higher rates of early recanalization, without increasing the risk of ICH. Our results do not warrant withholding IVT prior to EVT. |
| Databáze: | OpenAIRE |
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