Effect of baseline infarct size on endovascular thrombectomy with or without intravenous alteplase in stroke patients: A subgroup analysis of a randomized trial (DIRECT-MT)

被引:12
作者
Jia, Zhen Yu [1 ]
Zhang, Yong Xin [2 ]
Cao, Yue Zhou [1 ]
Zhao, Lin Bo [1 ]
Shi, Hai Bin [1 ]
Zhang, Lei [2 ]
Li, Zi Fu [2 ]
Shen, Hong Jian [2 ]
Lou, Min [3 ]
Zhang, Yong Wei [4 ]
Yin, Guo Cong [5 ]
Ye, Xiao Fei [6 ]
Yang, Peng Fei [2 ]
Liu, Sheng [1 ]
Liu, Jian Min [2 ]
机构
[1] Nanjing Med Univ, Dept Radiol, Affiliated Hosp 1, 300 Guangzhou Rd, Nanjing 210029, Jiangsu, Peoples R China
[2] Naval Med Univ, Dept Neurosurg, Changhai Hosp, Shanghai, Peoples R China
[3] Zhejiang Univ, Dept Neurol, Affiliated Hosp 2, Hangzhou, Peoples R China
[4] Naval Med Univ, Dept Neurol, Changhai Hosp, Shanghai, Peoples R China
[5] Zhejiang Univ, Dept Neurol, Hangzhou Peoples Hosp 1, Hangzhou, Peoples R China
[6] Naval Med Univ, Dept Stat, Shanghai, Peoples R China
关键词
acute ischemic stroke; alteplase; ASPECTS; thrombectomy; EARLY CT SCORE; ISCHEMIC-STROKE; MECHANICAL THROMBECTOMY; INTRAARTERIAL TREATMENT; THERAPY; THROMBOLYSIS; TPA; RECANALIZATION; REPERFUSION; OUTCOMES;
D O I
10.1111/ene.15276
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and purpose DIRECT-MT showed that endovascular thrombectomy was noninferior to thrombectomy preceded by intravenous alteplase with regard to functional outcome in patients with acute ischemic stroke. In this post hoc analysis, we examined whether infarct size modified the effect of alteplase. Methods All patients with baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) grades were included. The primary outcome was the 90-day modified Rankin Scale (mRS) score. Multivariate ordinal logistic regression analysis was used to calculate the adjusted common odds ratio (OR) for better functional outcome based on the mRS for thrombectomy alone versus combination therapy. An interaction term was entered to test for an interaction with baseline ASPECTS subgroups: 0-4 versus 5-7 versus 8-10. Results Of 649 patients, 323 (49.8%) were in the thrombectomy-alone group and 326 (50.2%) in the combination-therapy group. There was no significant treatment-by-trichotomized ASPECTS interaction with alteplase prior to endovascular treatment for the primary endpoint of ordinal mRS (p-value interaction term relative to ASPECTS 8-10: ASPECTS 0-4, p = 0.386; ASPECTS 5-7, p = 0.936). Adjusted common ORs for improvement in the 90-day mRS with thrombectomy alone compared with combination therapy were 1.99 (95% confidence interval = 0.72-5.46) for ASPECTS 0-4, 1.07 (0.62-1.86) for ASPECTS 5-7, and 1.03 (0.74-1.45) for ASPECTS 8-10. There was no significant difference in the safety outcomes between the two groups. Conclusions Baseline infarct size may not modify the effect of alteplase prior to endovascular thrombectomy with regard to favorable functional outcomes and adverse events.
引用
收藏
页码:1643 / 1651
页数:9
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