Abstract
O-022 Is IV-tPA administration associated with higher rates of favorable outcomes in MeVO patients treated with mechanical thrombectomy?
Journal of neurointerventional surgery, Vol.16(Suppl 1), pp.A16-A17
07/21/2024
DOI: 10.1136/jnis-2024-SNIS.22
Abstract
IntroductionThe growing solid evidence of the efficacy of Mechanical thrombectomy (MT) for large vessel occlusion has expanded the field for more distal circulation stroke such as the medium vessel occlusion (MeVO), with currently ongoing clinical trials. Consequently, the effectiveness and safety of using IV-tPA as a bridging therapy for MT in MeVO has not been thoroughly investigated.MethodsIn this retrospective cohort, patients with MT on MeVO were selected using stroke thrombectomy & aneurysm registry (STAR) that includes data from 31 centers internationally. MeVO was defined as the involvement of A2, A3, M2, M3, P2, P3 segments. They were categorized into two groups based on IV-tPA administration. Propensity score matching was performed with the adjustment for sex, age, onset to groin Time, Alberta stroke program early CT score (ASPECTS), admission National Institutes of Health Stroke Scale (NIHSS), Pre-Stroke modified ranking scale (mRS), prior Stroke, and atrial fibrillation. Primary outcome was defined as achieving a 90-day mRS of 0–2. Secondary outcomes were successful recanalization (modified Thrombolysis in Cerebral Infarction ≥ 2b), 90-day mRS of 0–1, symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage within 24 hours (asymptomatic and symptomatic ICH), and mortality.ResultsOf the 10,730 stroke patients, 1,419 patients were found to have an MeVO that underwent mechanical thrombectomy. After conduction of propensity matching analysis, 259 were matched in each arm. Among 518 patients, 276(53%) were female and the median age was 71 of which 326(67%) were white, 92 (18.8%) black, 22(4.5%) Hispanic and 50(10.2) others. The median admission NIHSS Score was 12 (7–18) and the ASPECTS was 9 (8–10). There was no statistically significant difference in the 90-day mRS 0–2 [aOR 1.03(0.80–1.60), P= 0.48], and 90-day mRS 0–1 [aOR 1.09(0.76–1.55), P= 0.65]. Successful recanalization was achieved in 49.8% of MeVO with IV-tPA versus 50.2% in those without IV-tPA (P=0.78). ICH within 24 hours and mortality showed no statistically significant difference between the two groups, [aOR 0.98(0.66–1.43), P=0.90; aOR 0.68(0.43–1.06), P=0.09]. SICH was more observed in patients with IV-tPA [OR 2.43(0.99–5.96), P=0.04].ConclusionOur results suggest no benefit of bridging therapy with IV-tPA for improvement of favorable clinical outcome among patients with MeVO who underwent mechanical thrombectomy, and it was associated with higher rates of SICH.Abstract O-022 Figure 1Disclosures M. Sowlat: None. J. Isidor: None. L. Maniakhina: None. H. Matsukawa: 2; C; B. Braun. . 3; C; Daiichi-Sankyo, Stryker. C. M. Cunningham: None. S. Samir Elawady: None. R. Abo Kasem: None. A. Orscelik: None. I. Maier: 3; C; Pfizer, Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M Starke: 1; C; NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of Health (R01NS111119–01A1) and (UL1, RMS has an unrestricted research grant from Medtronic and Balt. 2; C; Penumbra, Abbott, Medtronic, Balt, InNeuroCo, Cerenovus, Naglreiter, Tonbridge, Von Medical, and Optimize Vascular. M. Psychogios: 1; C; Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial., Unrestricted Grants for the DISTAL trial from Stryker Neurovascular Inc., Phenox GmbH, Penumbra Inc. and Rapid Medical Inc., Sponsor-PI SPINNERS trial (Funded by a Siemens Healthineers AG Grant), Research agreement with Siemens Healthineers AG, Local PI for the ASSIST, EXCELLENT, TENSION, COATING, SURF and ESCAPE-NEXT trials. 3; C; Speaker fees: Stryker Neurovascular Inc., Medtronic Inc., Penumbra Inc., Acandis GmbH, Phenox GmbH, Siemens Healthineers AG. E. A Samaniego: 2; C; Medtronic, microvention, Rapid Medical. N. Goyal: None. S. Yoshimura: 3; C; Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar: 2; C; Medtronic and Microvention. J. A. Grossberg: 1; C; Georgia Research Alliance, Emory Medical Care Foundation, Neurosurgery Catalyst. 2; C; Cognition, Imperative Care. A. Alawieh: None. A. Alaraj: 2; C; Cerenovus. M. Ezzeldin: 2; C; Viz.ai and Imperative care. 4; C; Galaxy Therapeutics. D. G. Romano: 2; C; Penumbra, Balt, Microvention, Phenox. O. Tanweer: 1; C; Q’apel Inc, Steinberg Foundation. 2; C; Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. 6; C; Proctor: Microvention Inc, Medtronic Inc. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: 2; C; Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular. R. Crosa: None. C. Matouk: 1; C; Speaker for Penumbra and Silk Road Medical. 2; C; Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. M. S. Park: 2; C; Medtronic. M. R. Levitt: 1; C; nrestricted educational grants from Medtronic and Stryker. 2; C; Medtronic, Aeaean Advisers and Metis Innovative. 6; C; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereotaxis, Fluid Biomed, and Hyperion Surgical; editorial board of Journal of NeuroInterventional Surgery; Data safety monitoring board of Ar. W. Brinjikji: 2; C; He receives consulting fees from Medtronic, Stryker, Imperative Care, Microvention, MIVI Neurovascular, Cerenovus, Asahi, and Balt. 6; C; Holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular, He receives royalties from Medtronic and Balloon Guide Catheter Technology, He serves in a leadership or fiduciary role for MIVI Neurovascular, Marblehead Medical LLC, Interventional Neuroradiology (Editor in Chief), Piraeus Medical, and WFITN. M. Moss: None. E. Daglioglu: None. R. Williamson Jr: 2; C; Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. 2; C; Consultant for Imperative Care and Stryker Neurovascular. 4; C; Stock ownership in Vena Medical. R. De Leacy: 1; C; Research grants from Siemens Healthineers and Kaneka medical. 2; C; Consultant for Cerenovus, Stryker Neurovascular and Sim & Cure. Minor equity interest Vastrax, Borvo medical, Synchron, Endostream, Von Vascular, Radical catheters and Precision Recovery Inc. 6; C; PI for Imperative Trial;. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. D. J Altschul,: 2; C; MicroVention, Stryker, and Cerenovus. A. M Spiotta: 2; C; Penumbra, Terumo, RapidAI, Cerenovus.
Details
- Title: Subtitle
- O-022 Is IV-tPA administration associated with higher rates of favorable outcomes in MeVO patients treated with mechanical thrombectomy?
- Creators
- M Sowlat - Medical University of South CarolinaJ Isidor - Medical University of South CarolinaL Maniakhina - Edward Via College of Osteopathic MedicineH Matsukawa - Medical University of South CarolinaC M Cunningham - Medical University of South CarolinaS Samir Elawady - Medical University of South CarolinaR Abo Kasem - Medical University of South CarolinaA Orscelik - Medical University of South CarolinaI Maier - Universitätsmedizin GöttingenP Jabbour - Thomas Jefferson UniversityJ Kim - Chonnam National University HospitalS Quintero Wolfe - Central Baptist HospitalA Rai - West Virginia UniversityR M Starke - University of Miami Health SystemM Psychogios - University Hospital of BaselE A Samaniego - University of IowaN Goyal - University of Tennessee at KnoxvilleS Yoshimura - Hyogo Medical UniversityH Cuellar - Louisiana State University Health Sciences Center ShreveportJ A Grossberg - Emory UniversityA Alawieh - Emory UniversityA Alaraj - University of ChicagoM Ezzeldin - University of HoustonD G Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'AragonaO Tanweer - Baylor College of MedicineJ Mascitelli - The University of Texas Health Science Center at San AntonioI Fragata - Universidade Nova de LisboaA Polifka - University of FloridaF Siddiqui - Neurosurgery, University of Michigan Health West, Wyoming, MIJ Osbun - Washington University in St. LouisR Grandhi - University of UtahR Crosa - Universidad de MontevideoC Matouk - University of New HavenM S Park - University of VirginiaM R Levitt - University of WashingtonW Brinjikji - Mayo ClinicM Moss - Washington Regional Medical CenterE Daglioglu - Ankara Bilkent City HospitalR Williamson - Allegheny General HospitalP Navia - Hospital Universitario La PazP Kan - The University of Texas Medical Branch at GalvestonR De Leacy - Mount Sinai Health SystemS Chowdhry - NorthShore University HealthSystemD J Altschul - Albert Einstein College of MedicineA M Spiotta - Medical University of South Carolina
- Resource Type
- Abstract
- Publication Details
- Journal of neurointerventional surgery, Vol.16(Suppl 1), pp.A16-A17
- DOI
- 10.1136/jnis-2024-SNIS.22
- ISSN
- 1759-8478
- eISSN
- 1759-8486
- Publisher
- BMJ Publishing Group Ltd
- Language
- English
- Date published
- 07/21/2024
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984688446302771
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