Stroke: Vascular and Interventional Neurology (Mar 2023)

Abstract Number ‐ 240: Association of intravenous thrombolysis and pre‐interventional reperfusion: a post‐hoc analysis of the SWIFT DIRECT trial

  • Adnan Mujanovic,
  • Omer Eker,
  • Gaultier Marnat,
  • Daniel Strbian,
  • Petra Ijäs,
  • Cécile Preterre,
  • Aude Triquenot,
  • Jean François Albucher,
  • Maxime Gauberti,
  • David Weisenburger‐Lile,
  • Marielle Ernst,
  • Omid Nikoubashman,
  • Anastasios Mpotsaris,
  • Benjamin Gory,
  • Vi Tuan Hua,
  • Marc Ribo,
  • David Liebeskind,
  • Tomas Dobrocky,
  • Thomas Meinel,
  • Lukas Bütikofer,
  • Jan Gralla,
  • Urs Fischer,
  • Johannes Kaesmacher

DOI
https://doi.org/10.1161/SVIN.03.suppl_1.240
Journal volume & issue
Vol. 3, no. S1

Abstract

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Introduction One potential benefit of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) is pre‐interventional reperfusion. Currently, there is a paucity of data regarding the occurrence of pre‐interventional reperfusion in patients randomized to IVT or no‐IVT before MT. Methods SWIFT DIRECT was a randomized controlled trial including acute ischemic stroke IVT‐eligible patients being directly admitted to a comprehensive stroke center, with allocation to either MT alone or IVT + MT. Primary endpoint of this analysis was the occurrence of pre‐interventional reperfusion defined as pre‐interventional expanded Thrombolysis in Cerebral Infarction score ≥ 2a. The effect of IVT and potential treatment effect heterogeneity were analyzed using logistic regression analyses. Results Out of the 396 patients analyzed, pre‐interventional reperfusion occurred in 20 (10.0%) of patients randomized to IVT+MT, and 7 (3.6%) of patients randomized to MT alone. Receiving IVT favored the occurrence of pre‐interventional reperfusion (aOR 2.91 [95% CI 1.23 – 6.87]). There was no IVT treatment effect heterogeneity on the occurrence of pre‐interventional reperfusion with different strata of Randomization‐to‐Groin‐Puncture (p for interaction = 0.33), although the effect tended to be stronger in patients with Randomization‐to‐Groin‐Puncture >28 minutes (aOR 4.65 [95% CI 1.16 – 18.68]). There were no significant difference in rates of functional outcomes between patients with and without pre‐interventional reperfusion. Conclusions Even for patients with proximal large vessel occlusions and direct access to MT, IVT leads towards an absolute increase of 6.9% (95% CI 1.7‐12.2%) in the rates of pre‐interventional reperfusion. The effect of IVT tended to be more pronounced when Randomization‐to‐Groin‐Puncture intervals were longer, but this heterogeneity did not reach statistical significance.