Intravenous thrombolysis prior to endovascular treatment in posterior circulation occlusions; a MR CLEAN Registry study.
medRxiv (Cold Spring Harbor Laboratory)（2023）
摘要
Background and aims The effectiveness of intravenous thrombolysis (IVT) prior to endovascular treatment (EVT) has been investigated in randomized trials and meta-analyses. These studies mainly concerned anterior circulation occlusions. We aimed to investigate clinical, technical, and safety outcomes of IVT prior to EVT in posterior circulation occlusions in a nationwide registry. Methods Patients were included from the MR CLEAN Registry: a nationwide, prospective, multicenter registry of patients with acute ischemic stroke (AIS) due to a large intracranial vessel occlusion receiving EVT between 2014 and 2019. All patients with a posterior circulation occlusion were included. Primary outcome was a shift towards better functional outcome on the modified Rankin scale (mRS) at 90 days. Secondary outcomes were favorable functional outcome (mRS 0-3), occurrence of symptomatic intracranial hemorrhages (sICH), successful reperfusion (eTICI2B), first-attempt successful reperfusion, and mortality at 90 days. Regression analyses with adjustments based on univariate analyses and literature were applied. Results A total of 248 patients were included, who received either IVT (n=125) or no IVT (n=123) prior to EVT. Results show no differences in a shift on the mRS (acOR:1.04, 95%CI:0.61-1.76). Although sICH occurred more often in the IVT group (4.8% versus 2.4%), regression analysis did not show a significant difference (aOR:1.65, 95%CI:0.33-8.35). Successful reperfusion, favorable functional outcome, first-attempt successful reperfusion, and mortality did not differ between patients treated with and without IVT. Conclusions We found no significant differences in clinical, technical and safety outcomes between patients with a large vessel occlusion in the posterior circulation treated with or without IVT prior to endovascular therapy. Our results are in line with the literature on the anterior circulation.
### Competing Interest Statement
Disclosures CBLMM reports grants from the Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation, European Commission, Healthcare Evaluation Netherlands, and Stryker (all paid to institution); and is a (minority interest) shareholder of Nicolab. BJE reports grants from leading the Change Healthcare Evaluation program, and TKI-PPP Grant Topsector lifesciences (all paid to institution); and participates as a representative of the UEMS Neuroradiology Dutch, and as Board member of the Dutch Society of Radiology. P-JvD reports consulting fees from Stryker, Siemens, and Stryker (all paid to institution); participates in the advisory board of DX Medical solutions; and is shareholder of DX Medical Solutions. AJY reports grants from Medtronic, Cerenovus, Penumbra, Stryker, and Genentech; holds stock options in Nico-lab; and is a consultant for Vesalio, Cerenovus, Penumbra, and Philips, all outside the submitted work. WHvZ reports speaker fees from Stryker, Cerenovus, and Nicolab, and consulting fees from Philips (all paid to institution); participated in the advisory boards of WeTrust (Philips) and ANAIS (Anaconda) (all paid to institution); and participated in the advisory boards of InEcxtremis (CHU Montpellier, Montpellier, France) and DISTAL (University Hospital Basel, Basel, Switzerland), studies for which no payments were received. All other authors declare no competing interests.
### Funding Statement
Sources of Funding The MR CLEAN Registry (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke) was partly funded by Stichting Toegepast Wetenschappelijk instituut voor Neuromodulatie (TWIN), Erasmus MC University Medical Center, Maastricht University Medical Center, and Amsterdam University Medical Center.
### Author Declarations
I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.
Not Applicable
The details of the IRB/oversight body that provided approval or exemption for the research described are given below:
The MR CLEAN Registry study protocol was evaluated by the medical ethics committee of the Erasmus University Medical Center and permission was granted to carry out the study as a registry. The need for obtaining informed consent was waived (MEC-2014-235).
I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.
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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).
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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.
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Source data will not be made available because of legislative issues on patient privacy. Detailed statistical analyses and analytic methods will be made available on reasonable request to the corresponding author.
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关键词
intravenous thrombolysis,posterior circulation occlusions,,endovascular treatment
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