Effect of Intravenous Alteplase Treatment on First-Line Stent Retriever Versus Aspiration Alone During Endovascular Treatment

• DOI: 10.1161/strokeaha.121.038390
• Publication Date: 2022-07-28T18:52:48Z
• Authors: Leon A. Rinkel; Kilian M. Treurniet; Daan Nieboer; Manon Kappelhof; Natalie E. LeCouffe; Agnetha A.E. Brug...; Wim H. van Zwam; Geert J. Lycklama...; Elyas Ghariq; Maarten Uyttenboo...; Diederik W.J. Dippel; Yvo B.W.E.M. Roos; Jonathan M. Coutinho; Charles B.L.M. Ma...; Bart J. Emmer; Bob Roozenbeek; Adriaan van Es; Inger de Ridder; Bart van der Worp; Rob Lo; Koos Keizer; Rob Gons; Lonneke Yo; Jelis Boiten; Ido van den Wijng...; Jeanette Hofmeijer; Jasper Martens; Wouter Schonewille; Jan Albert Vos; Anil Tuladhar; Floris Schreuder; Jeroen Boogaarts; Sjoerd Jenniskens; Karlijn de Laat; Lukas van Dijk; Heleen den Hertog; Boudewijn van Has...; Paul Brouwers; Emiel Sturm; Tomas Bulut; Michel Remmers; Anouk van Norden; Thijs de Jong; Anouk Rozeman; Otto Elgersma; Reinoud Bokkers; Julia van Tuijl; Issam Boukrab; Hans Kortman; Vincent Costalat; Caroline Arquizan; Robin Lemmens; Jelle Demeestere; Philippe Desfonta...; Denis Brisbois; Frédéric Clarençon; Yves Samson; Adriaan van Es; Jelis Boiten; Lonneke Yo; Koos Keizer; Martin Brown; Phil White; John Gregson; Rick van Nuland; Aad van der Lugt; Linda Jacobi; René van den Berg; Ludo Beenen; Adriaan van Es; Pieter-Jan van Do...; Ido van den Wijng...; Albert Yoo; Lonneke Yo; Jasper Martens; Bas Hammer; Stefan Roosendaal; Anton Meijer; Menno Krietemeijer; Reinoud Bokkers; Anouk van der Hoorn; Dick Gerrits; Robert van Oosten...; Ben Jansen; Sanne Manschot; Henk Kerkhof; Ido van den Wijng...; Peter Koudstaal; Koos Keizer; Hester Lingsma; Vicky Chalos; Olvert Berkhemer; Aad van der Lugt; Adriaan Versteeg; Lennard Wolff; Jiahang Su; Manon Tolhuisen; Henk van Voorst; Hugo ten Cate; Moniek de Maat; Samantha Donse-Do...; Heleen van Beusekom; Aladdin Taha; Vicky Chalos; Sophie van den Berg; Rob van de Graaf; Robert-Jan Goldhoorn; Aladdin Taha; Samantha Donse-Do...; Wouter Hinsenveld; Anne Pirson; Lotte Sondag; Rik Reinink; Manon Tolhuisen; Josje Brouwer; Lennard Wolff; Sabine Collette; Wouter van der Steen; Rita Sprengers; Martin Sterrenberg; Naziha El Ghannouti; Sabrina Verheesen; Wilma Pellikaan; Kitty Blauwendraat; Yvonne Drabbe; Joke de Meris; Michelle Simons; Hester Bongenaar; Anja van Loon; Eva Ponjee; Rieke Eilander; Suze Kooij; Marieke de Jong; Esther Santegoets; Suze Roodenburg; Ayla van Ahee; Marinette Moynier; Annemie Devroye; Evelyn Marcis; Ingrid Iezzi; Annie David; Atika Talbi; Leontien Heiligers; Yvonne Martens
• Keywords: Stroke; Post-hoc analysis

Background: We aimed to assess whether the effect of intravenous alteplase treatment (IVT) before endovascular (EVT) on outcome is modified by first-line technique during EVT in IVT eligible patients. Methods: This was a post hoc analysis from MR CLEAN-NO IV (Multicenter Randomized Clinical Trial Endovascular Treatment for Acute Ischemic Stroke Netherlands - Intravenous Followed Intra-Arterial Versus Direct Caused Proximal Intracranial Occlusion), randomized trial followed versus alone patients presenting directly EVT-capable centers. included data all who underwent with thrombectomy attempt. compared treated stent retriever (with or without aspiration) aspiration as and assessed interaction treatment. Primary 90-day Rankin Scale score, analyzed mixed model ordinal regression shift towards better outcome. Secondary outcomes successful reperfusion (extended Thrombolysis Cerebral Infarction score 2b–3). Results: Of 473 patients, 102 (21.6%) were technique. In full population, functional similar only (adjusted common odds ratio [acOR]‚ 1.07 [95% CI, 0.69–1.66]). observed significant between ( P =0.03). aspiration-only group, had worse those (acOR, 0.44 0.21–0.90]). did not differ 1.08 0.74–1.57]). There no statistically reperfusion. Conclusions: IV, Patients clinical if they receive IVT. No such difference retrievers. Confirmation pooling results other trials needed confirm these findings.