TY - JOUR
T1 - Intravenous alteplase has different effects on the efficacy of aspiration and stent retriever thrombectomy
T2 - analysis of the COMPASS trial
AU - Mokin, Maxim
AU - Waqas, Muhammad
AU - Fifi, Johanna T.
AU - De Leacy, Reade
AU - Fiorella, David
AU - Levy, Elad I.
AU - Snyder, Kenneth
AU - Hanel, Ricardo A.
AU - Woodward, Keith
AU - Chaudry, Imran
AU - Rai, Ansaar T.
AU - Frei, Donald
AU - Delgado Almandoz, Josser E.
AU - Kelly, Michael
AU - Arthur, Adam S.
AU - Baxter, Blaise W.
AU - English, Joey
AU - Linfante, Italo
AU - Fargen, Kyle M.
AU - Turk, Aquilla
AU - Mocco, J.
AU - Siddiqui, Adnan H.
N1 - Publisher Copyright:
© 2022 BMJ Publishing Group. All rights reserved.
PY - 2022/10
Y1 - 2022/10
N2 - Background There is conflicting evidence on the utility of intravenous (IV) alteplase in patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). Methods This was a post hoc analysis of the COMPASS: a trial of aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion. We compared clinical, procedural and angiographic outcomes of patients with and without prior IV alteplase administration. Results In the COMPASS trial, 235 patients had presented to the hospital within the first 4 hours of stroke symptom onset and were eligible for analysis. On univariate analysis, administration of IV alteplase prior to MT was found to be significantly associated with favorable outcomes (modified Rankin scale (mRS) 0–2 at 3 months; 55.6% vs 40.0% in the MT-only group, P=0.037). However, on multivariate analysis, only baseline (pre-stroke) mRS, admission National Institutes of Health Stroke Scale (NIHSS) score and age were identified as independent predictors of favorable outcomes at 3 months. We found higher final thrombolysis in cerebral infarction (TICI) 2b/3 rates in patients without the use of alteplase prior to the aspiration first approach (100.0% vs 87.9% in IV altepase +aspiration first MT, P=0.03). In the stent retriever first group, final TICI 2b/3 rates were identical in patients with and without IV alteplase administration (87.5% and 87.5%, P=1.0). Conclusions Prior administration of IV alteplase may adversely affect the efficacy of aspiration, but does not seem to influence the stent retriever first approach to MT in patients with anterior circulation ELVO.
AB - Background There is conflicting evidence on the utility of intravenous (IV) alteplase in patients with emergent large vessel occlusion (ELVO) treated with mechanical thrombectomy (MT). Methods This was a post hoc analysis of the COMPASS: a trial of aspiration thrombectomy versus stent retriever thrombectomy as first-line approach for large vessel occlusion. We compared clinical, procedural and angiographic outcomes of patients with and without prior IV alteplase administration. Results In the COMPASS trial, 235 patients had presented to the hospital within the first 4 hours of stroke symptom onset and were eligible for analysis. On univariate analysis, administration of IV alteplase prior to MT was found to be significantly associated with favorable outcomes (modified Rankin scale (mRS) 0–2 at 3 months; 55.6% vs 40.0% in the MT-only group, P=0.037). However, on multivariate analysis, only baseline (pre-stroke) mRS, admission National Institutes of Health Stroke Scale (NIHSS) score and age were identified as independent predictors of favorable outcomes at 3 months. We found higher final thrombolysis in cerebral infarction (TICI) 2b/3 rates in patients without the use of alteplase prior to the aspiration first approach (100.0% vs 87.9% in IV altepase +aspiration first MT, P=0.03). In the stent retriever first group, final TICI 2b/3 rates were identical in patients with and without IV alteplase administration (87.5% and 87.5%, P=1.0). Conclusions Prior administration of IV alteplase may adversely affect the efficacy of aspiration, but does not seem to influence the stent retriever first approach to MT in patients with anterior circulation ELVO.
UR - http://www.scopus.com/inward/record.url?scp=85130475414&partnerID=8YFLogxK
U2 - 10.1136/neurintsurg-2021-017943
DO - 10.1136/neurintsurg-2021-017943
M3 - Article
C2 - 34649935
AN - SCOPUS:85130475414
SN - 1759-8478
VL - 14
SP - 992
EP - 996
JO - Journal of NeuroInterventional Surgery
JF - Journal of NeuroInterventional Surgery
IS - 10
ER -