WSO EXPRESS: Thrombolysis outcomes according to arterial characteristics of acute ischemic stroke by alteplase dose and blood pressure target,International Journal of Stroke

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WSO EXPRESS: Thrombolysis outcomes according to arterial characteristics of acute ischemic stroke by alteplase dose and blood pressure target
International Journal of Stroke ( IF 6.7 ) Pub Date : 2021-06-07 , DOI: 10.1177/17474930211025436
Zien Zhou _{1,

2} , Chao Xia _{1,

3} , Grant Mair ₄ , Candice Delcourt _{1,

5} , Sohei Yoshimura _{1,

6} , Xiaosheng Liu ₇ , Zengai Chen ₂ , Alejandra Malavera ₁ , Cheryl Carcel _{1,

8,

9} , Xiaoying Chen _{1,

9} , Xia Wang ₁ , Rustam Al-Shahi Salman ₁₀ , Thompson G Robinson ₁₁ , Richard I Lindley ₁₂ , John Chalmers ₁ , Joanna M Wardlaw _{4,

13} , Mark W Parsons _{14,

15} , Andrew M Demchuk _{16,

17} , Craig S Anderson _{1,

8,

18}

Affiliation

211065The George Institute for Global Health, Faculty of Medicine, 7800University of New South Wales, Sydney, Australia.
Department of Radiology, Ren Ji Hospital, School of Medicine, 12474Shanghai Jiao Tong University, Shanghai, PR China.
Department of Neurosurgery, West China Hospital, 12530Sichuan University, Chengdu, PR China.
Edinburgh Imaging and Centre for Clinical Brain Sciences, 3124University of Edinburgh, Edinburgh, UK.
Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park, Australia.
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Nuclear Medicine, 12478Fudan University Shanghai Cancer Center, Shanghai, PR China.
Department of Neurology, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, Australia.
Sydney Medical School, University of Sydney, Sydney, Australia.
Centre for Clinical Brain Sciences, 3124University of Edinburgh, Edinburgh, UK.
Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Center, 4488University of Leicester, Leicester, UK.
Western Clinical School, University of Sydney, Sydney, Australia.
UK Dementia Research Institute, 3124University of Edinburgh, Edinburgh, UK.
South Western Clinical School, 7800University of New South Wales, Sydney, Australia.
Melbourne Brain Centre, Royal Melbourne Hospital, Department of Medicine, University of Melbourne, Melbourne, Australia.
Department of Clinical Neurosciences, 157742Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Department of Radiology, 157742Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
The George Institute China at Peking University Health Science Center, Beijing, PR China.

Background: We explored the influence of low-dose intravenous alteplase and intensive blood pressure (BP) lowering on outcomes of acute ischemic stroke (AIS) according to status/location of vascular obstruction in participants of the Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).

Methods: ENCHANTED was a multicenter, quasi-factorial, randomized trial to determine efficacy and safety of low- versus standard-dose intravenous alteplase and intensive- versus guideline-recommended BP lowering in AIS patients. In those who had baseline CT or MRI angiography, the degree of vascular occlusion was grouped according to being no (NVO), medium (MVO), or large (LVO). Logistic regression models were used to determine 90-day outcomes (modified Rankin scale [mRS] shift [primary], other mRS cut-scores, intracranial hemorrhage, early neurologic deterioration [END], and recanalization) by vascular obstruction status/site. Heterogeneity in associations for outcomes across subgroups was estimated by adding an interaction term to the models.

Results: There were 940 participants: 607 in alteplase arm only, 243 in BP arm only, and 90 assigned to both arms. Compared to the NVO group, functional outcome was worse in LVO (mRS shift, adjusted OR [95% CI] 2.13 [1.56-2.90] but comparable in MVO (1.34 [0.96-1.88]) groups. There were no differences in associations of alteplase dose or BP lowering and outcomes across NVO/MVO/LVO groups (mRS shift: low versus standard alteplase dose 0.84 [0.54-1.30]/0.48 [0.25-0.91]/0.99 [0.75-2.09], Pinteraction=0.28; intensive versus standard BP lowering 1.32 [0.74-2.38]/0.78 [0.31-1.94]/1.24 [0.64-2.41], Pinteraction=0.41), except for a borderline significant difference for intensive BP lowering and increased END (0.63 [0.14-2.72]/0.17 [0.02-1.47]/2.69 [0.90-8.04], Pinteraction=0.05).

Conclusions: Functional outcome by dose of alteplase or intensity of BP lowering is not modified by vascular obstruction status/site according to analyzes from ENCHANTED, although these results are compromised by low statistical power.

中文翻译：

WSO EXPRESS：根据阿替普酶剂量和血压目标的急性缺血性卒中动脉特征的溶栓结果

背景：我们根据强化控制高血压和溶栓卒中研究参与者的血管阻塞状态/位置，探讨了低剂量静脉阿替普酶和强化血压 (BP) 降低对急性缺血性卒中 (AIS) 结局的影响。着迷）。

方法：ENCHANTED 是一项多中心、准因素、随机试验，旨在确定 AIS 患者中低剂量与标准剂量静脉阿替普酶以及强化降压与指南推荐降压的有效性和安全性。在进行基线 CT 或 MRI 血管造影的患者中，血管闭塞程度根据无 (NVO)、中等 (MVO) 或大 (LVO) 进行分组。逻辑回归模型用于根据血管阻塞状态/部位确定 90 天结果（改良 Rankin 量表 [mRS] 偏移 [主要]、其他 mRS 切分、颅内出血、早期神经功能恶化 [END] 和再通）。通过在模型中添加交互项来估计亚组结果关联的异质性。

结果：共有 940 名参与者：仅阿替普酶组 607 人，仅 BP 组 243 人，90 人分配到双臂。与 NVO 组相比，LVO 的功能结果更差（mRS 偏移，调整后的 OR [95% CI] 2.13 [1.56-2.90]，但在 MVO（1.34 [0.96-1.88]）组中具有可比性。阿替普酶剂量或血压降低和 NVO/MVO/LVO 组的结果（mRS 偏移：低与标准阿替普酶剂量 0.84 [0.54-1.30]/0.48 [0.25-0.91]/0.99 [0.75-2.09]，Pinteraction=0.28；强化与标准 BP 降低 1.32 [0.74-2.38]/0.78 [0.31-1.94]/1.24 [0.64-2.41]，Pinteraction=0.41），除了强化降压和 END 增加的临界显着差异（0.63 [0.14-2.72]/ 0.17 [0.02-1.47]/2.69 [0.90-8.04]，Pinteraction=0.05）。

结论：根据 ENCHANTED 的分析，阿替普酶剂量或血压降低强度的功能结果不会因血管阻塞状态/部位而改变，尽管这些结果受到低统计功效的影响。

更新日期：2021-06-07

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