Should the extent of infarction modify the decision to use bridging thrombolytic prior to endovascular thrombectomy?

Campbell, Bruce C.V.

doi:10.1111/ene.15322

Cited by 2 publications

(1 citation statement)

References 8 publications

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“…In general, patients with extensive hypoperfusion on baseline imaging are considered more suitable candidates for EVT alone -hypothesizing that patients with more extensive infarct at baseline have a higher risk of hemorrhagic transformation after IVT using alteplase [8,9]. The extent of the baseline infarct is commonly estimated using CT perfusion (CTP).…”

Section: Introductionmentioning

confidence: 99%

Association between computed tomography perfusion and the effect of intravenous alteplase prior to endovascular treatment in acute ischemic stroke

et al. 2023

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Purpose Intravenous alteplase (IVT) prior to endovascular treatment (EVT) is neither superior nor noninferior to EVT alone in acute ischemic stroke patients. We aim to assess whether the effect of IVT prior to EVT differs according to CT perfusion (CTP)–based imaging parameters. Methods In this retrospective post hoc analysis, we included patients from the MR CLEAN-NO IV with available CTP data. CTP data were processed using syngo.via (version VB40). We performed multivariable logistic regression to obtain the effect size estimates (adjusted common odds ratio a[c]OR) on 90-day functional outcome (modified Rankin Scale [mRS]) and functional independence (mRS 0-2) for CTP parameters with two-way multiplicative interaction terms between IVT administration and the studied parameters. Results In 227 patients, median CTP-estimated core volume was 13 (IQR 5–35) mL. The treatment effect of IVT prior to EVT on outcome was not altered by CTP-estimated ischemic core volume, penumbral volume, mismatch ratio, and presence of a target mismatch profile. None of the CTP parameters was significantly associated with functional outcome after adjusting for confounders. Conclusion In directly admitted patients with limited CTP-estimated ischemic core volumes who presented within 4.5 h after symptom onset, CTP parameters did not statistically significantly alter the treatment effect of IVT prior to EVT. Further studies are needed to confirm these results in patients with larger core volumes and more unfavorable baseline perfusion profiles on CTP imaging.

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Section: Introductionmentioning

confidence: 99%

Association between computed tomography perfusion and the effect of intravenous alteplase prior to endovascular treatment in acute ischemic stroke

et al. 2023

View full text Add to dashboard Cite

show abstract

Should the extent of infarction modify the decision to use bridging thrombolytic prior to endovascular thrombectomy?

Cited by 2 publications

References 8 publications

Association between computed tomography perfusion and the effect of intravenous alteplase prior to endovascular treatment in acute ischemic stroke

Association between computed tomography perfusion and the effect of intravenous alteplase prior to endovascular treatment in acute ischemic stroke

Should the extent of infarction modify the decision to use bridging thrombolytic prior to endovascular thrombectomy?

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