Academic Journal
Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy
| العنوان: | Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy |
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| المؤلفون: | Johannes Kaesmacher, Giovanni Peschi, Nuran Abdullayev, Basel Maamari, Tomas Dobrocky, Jan Vynckier, Eike Piechowiak, Raoul Pop, Daniel Behme, Peter B Sporns, Hanna Styczen, Pekka Virtanen, Lukas Meyer, Thomas R Meinel, Daniel Cantré, Christoph Kabbasch, Volker Maus, Johanna Pekkola, Sebastian Fischer, Anca Hasiu, Alexander Schwarz, Moritz Wildgruber, David J Seiffge, Sönke Langner, Nicolas Martinez-Majander, Alexander Radbruch, Marc Schlamann, Dan Mihoc, Rémy Beaujeux, Daniel Strbian, Jens Fiehler, Pasquale Mordasini, Jan Gralla, Urs Fischer |
| المصدر: | Clinical and Translational Neuroscience, Vol 5 (2021) |
| بيانات النشر: | MDPI AG, 2021. |
| سنة النشر: | 2021 |
| المجموعة: | LCC:Neurosciences. Biological psychiatry. Neuropsychiatry |
| مصطلحات موضوعية: | Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571 |
| الوصف: | Objective: To identify factors associated with early angiographic reperfusion improvement (EARI) following intra-arterial fibrinolytics (IAF) after failed or incomplete mechanical thrombectomy (MT). Methods: A subset of patients treated with MT and IAF rescue after incomplete reperfusion included in the INFINITY (INtra-arterial FIbriNolytics In ThrombectomY) multicenter observational registry was analyzed. Multivariable logistic regression was used to identify factors associated with EARI. Heterogeneity of the clinical effect of EARI on functional independence (defined as modified Rankin Score ≤2) was tested with interaction terms. Results: A total of 228 patients (median age: 72 years, 44.1% female) received IAF as rescue for failed or incomplete MT and had a post-fibrinolytic angiographic control run available (50.9% EARI). A cardioembolic stroke origin (adjusted odds ratio (aOR) 3.72, 95% confidence interval (CI) 1.39–10.0) and shorter groin puncture to IAF intervals (aOR 0.82, 95% CI 0.71–0.95 per 15-min delay) were associated with EARI, while pre-interventional thrombolysis showed no association (aOR 1.15, 95% CI 0.59–2.26). The clinical benefit of EARI after IAF seemed more pronounced in patients without or only minor early ischemic changes (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥9, aOR 4.00, 95% CI 1.37–11.61) and was absent in patients with moderate to severe ischemic changes (ASPECTS ≤8, aOR 0.94, 95% CI 0.27–3.27, p for interaction: 0.095). Conclusion: Early rescue and a cardioembolic stroke origin were associated with more frequent EARI after IAF. The clinical effect of EARI seemed reduced in patients with already established infarcts. If confirmed, these findings can help to inform patient selection and inclusion criteria for randomized-controlled trials evaluating IAF as rescue after MT. |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 2514-183X 2514183X |
| Relation: | https://doaj.org/toc/2514-183X |
| DOI: | 10.1177/2514183X211017363 |
| URL الوصول: | https://doaj.org/article/4321ff1c9be34730839d41bb699eeab7 |
| رقم الانضمام: | edsdoj.4321ff1c9be34730839d41bb699eeab7 |
| قاعدة البيانات: | Directory of Open Access Journals |
| تدمد: | 2514183X |
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| DOI: | 10.1177/2514183X211017363 |