Sònia Abilleira1, Aida Ribera2, Pedro Cardona2, Marta Rubiera2, Elena López-Cancio2, Sergi Amaro2, Ana Rodríguez-Campello2, Pol Camps-Renom2, David Cánovas2, Maria Angels de Miquel2, Alejandro Tomasello2, Sebastian Remollo2, Antonio López-Rueda2, Elio Vivas2, Joan Perendreu2, Miquel Gallofré2. 1. From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital Germans Trias i Pujol, Badalona, Spain (E.L.-C., S.R.); Department of Neuroscience, Hospital Clínic, Barcelona, Spain (S. Amaro); Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain (A.R.-C.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (P.C.-R.); Neurology Department, Hospital del Parc Taulí, Sabadell, Spain (D.C.); Department of Endovascular Neuroradiology, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (M.A.d.M.); Neurointerventional Department, Hospital Vall d'Hebron, Barcelona, Spain (A.T.); Department of Neuroradiology, Hospital Clínic, Barcelona, Spain (A.L.-R.); Department of Interventional Neuroradiology, Hospital del Mar, Barcelona, Spain (E.V.); and Department of Neuroradiology, Hospital del Parc Taulí, Sabadell, Spain (J.P.). sabilleira@gencat.cat. 2. From the Stroke Program, Agency for Health Quality and Assessment of Catalonia, Barcelona, Spain (S. Abilleira, M.G.); CIBER Epidemiología y Salud Pública (CIBERESP) (S. Abilleira, M.G.); Cardiovascular Epidemiology Unit, Cardiology Department, Hospital Vall d'Hebron, Barcelona, Spain (A.R.); Neurology Department, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (P.C.); Stroke Unit, Neurology Department, Hospital Vall d'Hebron, Barcelona, Spain (M.R.); Department of Neurosciences, Hospital Germans Trias i Pujol, Badalona, Spain (E.L.-C., S.R.); Department of Neuroscience, Hospital Clínic, Barcelona, Spain (S. Amaro); Neurology Department, IMIM-Hospital del Mar, Barcelona, Spain (A.R.-C.); Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain (P.C.-R.); Neurology Department, Hospital del Parc Taulí, Sabadell, Spain (D.C.); Department of Endovascular Neuroradiology, Hospital de Bellvitge, Hospitalet de Llobregat, Spain (M.A.d.M.); Neurointerventional Department, Hospital Vall d'Hebron, Barcelona, Spain (A.T.); Department of Neuroradiology, Hospital Clínic, Barcelona, Spain (A.L.-R.); Department of Interventional Neuroradiology, Hospital del Mar, Barcelona, Spain (E.V.); and Department of Neuroradiology, Hospital del Parc Taulí, Sabadell, Spain (J.P.).
Abstract
BACKGROUND AND PURPOSE: Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients. METHODS: Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel-Haenszel test statistic. RESULTS: We included 599 direct EVT patients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74-1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74-1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25-1.27). CONCLUSIONS: This observational study suggests that outcomes after direct EVT or combined intravenous thrombolysis+EVT are not different. If confirmed by a randomized controlled trial, it may have a significant impact on organization of stroke systems of care.
BACKGROUND AND PURPOSE: Whether intravenous thrombolysis adds a further benefit when given before endovascular thrombectomy (EVT) is unknown. Furthermore, intravenous thrombolysis delays time to groin puncture, mainly among drip and ship patients. METHODS: Using region-wide registry data, we selected cases that received direct EVT or combined intravenous thrombolysis+EVT for anterior circulation strokes between January 2011 and October 2015. Treatment effect was estimated by stratification on a propensity score. The average odds ratios for the association of treatment with good outcome and death at 3 months and symptomatic bleedings at 24 hours were calculated with the Mantel-Haenszel test statistic. RESULTS: We included 599 direct EVTpatients and 567 patients with combined treatment. Stratification through propensity score achieved balance of baseline characteristics across treatment groups. There was no association between treatment modality and good outcome (odds ratio, 0.97; 95% confidence interval, 0.74-1.27), death (odds ratio, 1.07; 95% confidence interval, 0.74-1.54), or symptomatic bleedings (odds ratio, 0.56; 95% confidence interval, 0.25-1.27). CONCLUSIONS: This observational study suggests that outcomes after direct EVT or combined intravenous thrombolysis+EVT are not different. If confirmed by a randomized controlled trial, it may have a significant impact on organization of stroke systems of care.
Authors: Alejandro Tomasello; Marc Ribò; Laura Ludovica Gramegna; Fernando Melendez; Santiago Rosati; Manuel Moreu; Sonia Aixut; Alexandre Lüttich; Mariano Werner; Sebastian Remollo; Manuel Quintana; Pilar Coscojuela; David Hernandez; Lavinia Dinia; Antonio Lopez-Rueda; Marta Rubiera; Àlex Rovira Journal: Interv Neuroradiol Date: 2019-05-09 Impact factor: 1.610
Authors: Lars Kellert; Frank Arne Wollenweber; Götz Thomalla; Christian H Nolte; Jens Fiehler; Peter Arthur Ringleb; Franziska Dorn Journal: Eur Stroke J Date: 2017-08-17
Authors: Ronen R Leker; Jose E Cohen; David Tanne; David Orion; Gregory Telman; Guy Raphaeli; Jacob Amsalem; Jonathan Y Streifler; Hen Hallevi; Pavel Gavriliuc; Natan M Bornstein; Anat Horev; Nour Eddine Yaghmour Journal: Interv Neurol Date: 2018-07-04