Intravenous Alteplase is Associated with First Pass Effect in Stent-retriever but not ADAPT Thrombectomy,Clinical Neuroradiology

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Intravenous Alteplase is Associated with First Pass Effect in Stent-retriever but not ADAPT Thrombectomy
Clinical Neuroradiology ( IF 2.8 ) Pub Date : 2021-09-08 , DOI: 10.1007/s00062-021-01085-3
Keigo Shigeta ₁ , Kentaro Suzuki ₂ , Yuji Matsumaru ₃ , Masataka Takeuchi ₄ , Masafumi Morimoto ₅ , Ryuzaburo Kanazawa ₆ , Yohei Takayama ₇ , Yuki Kamiya ₈ , Seiji Okubo ₉ , Mikito Hayakawa ₃ , Norihiro Ishii ₁₀ , Yorio Koguchi ₁₁ , Takahiro Ota ₁₂ , Tomoji Takigawa ₁₃ , Masato Inoue ₁₄ , Hiromichi Naito ₁₅ , Teruyuki Hirano ₁₆ , Noriyuki Kato ₁₇ , Toshihiro Ueda ₁₈ , Kazunori Akaji ₁₉ , Yasuyuki Iguchi ₂₀ , Kazunori Miki ₂₁ , Wataro Tsuruta ₂₂ , Shigeru Fujimoto ₂₃ , Masaya Enomoto ₁ , Jiro Aoyama ₁ , Tomoyuki Nakano ₁ , Kazumi Kimura ₂ ,

Affiliation

Department of Neurosurgery, National Hospital Organization Disaster Medical Center, Tokyo, Japan.
Department of Neurology, Nippon Medical School Hospital, Tokyo, Japan.
Division of Stroke Prevention and Treatment, Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
Department of Neurosurgery, Seisho Hospital, Kanagawa, Japan.
Department of Neurosurgery, Yokohama Shintoshi Neurosurgery Hospital, Kanagawa, Japan.
Department of Neurosurgery, Nagareyama Central Hospital, Chiba, Japan.
Department of Neurology, Akiyama Neurosurgical Hospital, Kanagawa, Japan.
Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan.
Department of Cerebrovascular Medicine, NTT Medical Center Tokyo, Tokyo, Japan.
Department of Neurosurgery, New Tokyo Hospital, Chiba, Japan.
Department of Neurology and Neurosurgery, Chiba Emergency Medical Center, Chiba, Japan.
Department of Neurosurgery, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Department of Neurosurgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
Department of Neurosurgery, National Center for Global Health and Medicine, Tokyo, Japan.
Department of Neurosurgery, Funabashi Municipal Medical Center, Chiba, Japan.
Department of Stroke and Cerebrovascular Medicine, Kyorin University, Tokyo, Japan.
Department of Neurosurgery, Mito Medical Center, Ibaraki, Japan.
Department of Strokology, Stroke Center, St. Marianna University Toyoko Hospital, Kanagawa, Japan.
Department of Neurosurgery, Mihara Memorial Hospital, Gunma, Japan.
Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan.
Department of Endovascular surgery, Tokyo Medical and Dental University, Tokyo, Japan.
Department of Endovascular Neurosurgery, Toranomon Hospital, Tokyo, Japan.
Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan.

Purpose

To investigate the effect of alteplase, either combined with stent-retriever thrombectomy or a direct aspiration first pass technique (ADAPT), in patients with large-vessel occlusion stroke.

Methods

This was a retrospective post hoc analysis of data from The Direct Mechanical Thrombectomy in Acute LVO Stroke (SKIP) study. Patients were divided into two groups according to the first-line thrombectomy technique: stent-retriever and ADAPT. Each group was further divided into two subgroups, namely MT and MT + alteplase. The procedural outcomes, such as first pass effect (FPE) ratio and number of passes, were evaluated. The clinical outcomes included mRS score at 3 months.

Results

A total of 180 patients were included (116 in the stent-retriever group and 64 in the ADAPT group). No interaction was detected between the first-line technique and alteplase administration. In the stent-retriever group, after adjusting for factors associated with FPE, the adjusted odds ratio (95% confidence interval) of FPE of the MT + alteplase subgroup versus the MT subgroup was 3.57 (1.5–8.48) and in the ADAPT group it was 1.35 (0.37–4.91). With alteplase, the number of passes decreased with adjusted odds ratios of 0.59 (0.37–0.93) in the stent-retriever group but not in the ADAPT group. In both first-line technique groups, clinical outcomes did not differ between subgroups.

Conclusion

In the SKIP study, alteplase administration was associated with increased FPE when combined with stent-retriever thrombectomy, but not with ADAPT. We found no differences in the clinical outcomes.

中文翻译：

静脉内阿替普酶与支架取回器的首过效应相关，但与 ADAPT 血栓切除术无关

目的

研究阿替普酶联合支架取栓血栓切除术或直接抽吸首过技术 (ADAPT) 在大血管闭塞性卒中患者中的效果。

方法

这是对急性 LVO 卒中 (SKIP) 研究中直接机械血栓切除术数据的回顾性事后分析。根据一线取栓技术将患者分为两组：支架取栓和ADAPT。每组进一步分为两个亚组，即MT和MT+阿替普酶。评估了程序结果，例如首次通过效果 (FPE) 比率和通过次数。临床结果包括 3 个月时的 mRS 评分。

结果

共纳入 180 名患者（支架回收组 116 名，ADAPT 组 64 名）。在一线技术和阿替普酶给药之间未检测到相互作用。在支架回收器组中，在调整与 FPE 相关的因素后，MT + 阿替普酶亚组与 MT 亚组的 FPE 的调整优势比（95% 置信区间）为 3.57（1.5-8.48），而在 ADAPT 组中为为 1.35 (0.37–4.91)。使用阿替普酶，支架取回器组的通过次数减少，调整后的优势比为 0.59（0.37-0.93），但 ADAPT 组没有。在两个一线技术组中，亚组之间的临床结果没有差异。