Keigo Shigeta1, Kentaro Suzuki2, Yuji Matsumaru3, Masataka Takeuchi4, Masafumi Morimoto5, Ryuzaburo Kanazawa6, Yohei Takayama7, Yuki Kamiya8, Seiji Okubo9, Mikito Hayakawa3, Norihiro Ishii10, Yorio Koguchi11, Takahiro Ota12, Tomoji Takigawa13, Masato Inoue14, Hiromichi Naito15, Teruyuki Hirano16, Noriyuki Kato17, Toshihiro Ueda18, Kazunori Akaji19, Yasuyuki Iguchi20, Kazunori Miki21, Wataro Tsuruta22, Shigeru Fujimoto23, Masaya Enomoto24, Jiro Aoyama24, Tomoyuki Nakano24, Kazumi Kimura2. 1. Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan. shigetak5@yahoo.co.jp. 2. Department of Neurology, Nippon Medical School Hospital, Tokyo, Japan. 3. Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan. 4. Department of Neurosurgery, Seisho Hospital, Kanagawa, Japan. 5. Department of Neurosurgery, Yokohama Shintoshi Neurosurgery Hospital, Kanagawa, Japan. 6. Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan. 7. Department of Neurology, Akiyama Neurosurgical Hospital, Kanagawa, Japan. 8. Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan. 9. Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan. 10. Department of Neurosurgery, New Tokyo Hospital, Chiba, Japan. 11. Department of Neurology and Neurosurgery, Chiba Emergency Medical Center, Chiba, Japan. 12. Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan. 13. Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan. 14. Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan. 15. Department of Neurosurgery, Funabashi Municipal Medical Center, Chiba, Japan. 16. Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan. 17. Department of Neurosurgery, Mito Medical Center, Ibaraki, Japan. 18. Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kanagawa, Japan. 19. Department of Neurosurgery, Mihara Memorial Hospital, Gunma, Japan. 20. Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan. 21. Department of Endovascular surgery, Tokyo Medical and Dental University, Tokyo, Japan. 22. Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan. 23. Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan. 24. Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
Abstract
PURPOSE: To investigate the effect of alteplase, either combined with stent-retriever thrombectomy or a direct aspiration first pass technique (ADAPT), in patients with large-vessel occlusion stroke. METHODS: This was a retrospective post hoc analysis of data from The Direct Mechanical Thrombectomy in Acute LVO Stroke (SKIP) study. Patients were divided into two groups according to the first-line thrombectomy technique: stent-retriever and ADAPT. Each group was further divided into two subgroups, namely MT and MT + alteplase. The procedural outcomes, such as first pass effect (FPE) ratio and number of passes, were evaluated. The clinical outcomes included mRS score at 3 months. RESULTS: A total of 180 patients were included (116 in the stent-retriever group and 64 in the ADAPT group). No interaction was detected between the first-line technique and alteplase administration. In the stent-retriever group, after adjusting for factors associated with FPE, the adjusted odds ratio (95% confidence interval) of FPE of the MT + alteplase subgroup versus the MT subgroup was 3.57 (1.5-8.48) and in the ADAPT group it was 1.35 (0.37-4.91). With alteplase, the number of passes decreased with adjusted odds ratios of 0.59 (0.37-0.93) in the stent-retriever group but not in the ADAPT group. In both first-line technique groups, clinical outcomes did not differ between subgroups. CONCLUSION: In the SKIP study, alteplase administration was associated with increased FPE when combined with stent-retriever thrombectomy, but not with ADAPT. We found no differences in the clinical outcomes.
PURPOSE: To investigate the effect of alteplase, either combined with stent-retriever thrombectomy or a direct aspiration first pass technique (ADAPT), in patients with large-vessel occlusion stroke. METHODS: This was a retrospective post hoc analysis of data from The Direct Mechanical Thrombectomy in Acute LVO Stroke (SKIP) study. Patients were divided into two groups according to the first-line thrombectomy technique: stent-retriever and ADAPT. Each group was further divided into two subgroups, namely MT and MT + alteplase. The procedural outcomes, such as first pass effect (FPE) ratio and number of passes, were evaluated. The clinical outcomes included mRS score at 3 months. RESULTS: A total of 180 patients were included (116 in the stent-retriever group and 64 in the ADAPT group). No interaction was detected between the first-line technique and alteplase administration. In the stent-retriever group, after adjusting for factors associated with FPE, the adjusted odds ratio (95% confidence interval) of FPE of the MT + alteplase subgroup versus the MT subgroup was 3.57 (1.5-8.48) and in the ADAPT group it was 1.35 (0.37-4.91). With alteplase, the number of passes decreased with adjusted odds ratios of 0.59 (0.37-0.93) in the stent-retriever group but not in the ADAPT group. In both first-line technique groups, clinical outcomes did not differ between subgroups. CONCLUSION: In the SKIP study, alteplase administration was associated with increased FPE when combined with stent-retriever thrombectomy, but not with ADAPT. We found no differences in the clinical outcomes.
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Authors: Osama O Zaidat; Alicia C Castonguay; Italo Linfante; Rishi Gupta; Coleman O Martin; William E Holloway; Nils Mueller-Kronast; Joey D English; Guilherme Dabus; Tim W Malisch; Franklin A Marden; Hormozd Bozorgchami; Andrew Xavier; Ansaar T Rai; Michael T Froehler; Aamir Badruddin; Thanh N Nguyen; M Asif Taqi; Michael G Abraham; Albert J Yoo; Vallabh Janardhan; Hashem Shaltoni; Roberta Novakovic; Alex Abou-Chebl; Peng R Chen; Gavin W Britz; Chung-Huan J Sun; Vibhav Bansal; Ritesh Kaushal; Ashish Nanda; Raul G Nogueira Journal: Stroke Date: 2018-02-19 Impact factor: 7.914