Portal de Periódicos da CAPES

Post-Thrombolysis Recanalization in Stroke Referrals for Thrombectomy

2018; Lippincott Williams & Wilkins; Volume: 49; Issue: 12 Linguagem: Inglês

10.1161/strokeaha.118.022335

1524-4628

Pierre Seners, Guillaume Turc, Olivier Naggara, Hilde Hénon, Michel Piotin, Caroline Arquizan, Tae‐Hee Cho, Ana-Paula Narata, Bertrand Lapergue, Sébastien Richard, Laurence Legrand, Nicolas Bricout, Raphaël Blanc, Cyril Dargazanli, Benjamin Gory, Séverine Debiais, Marie Tisserand, Serge Bracard, X. Leclerc, Michaël Obadia, Vincent Costalat, Lise-Prune Berner, Jean-Philippe Cottier, Arturo Consoli, Xavier Ducrocq, Jean‐Louis Mas, Catherine Oppenheim, Jean‐Claude Baron, Marie Abrivard, Sonia Alamowitch, Wagih Ben Hassen, Yves Berthezène, Karine Blanc‐Lasserre, A. Boulin, Grégoire Boulouis, Stéphane Bouly, Frédéric Bourdain, David Calvet, Vladimir Charron, Mohamed Chbicheb, S. Condette–Auliac, Ovide Corabianu, Charlotte Cordonnier, Oguzhan Coskun, T. de Broucker, Jean-Pierre Decroix, Federico Di Maria, Serge Evrard, Mathieu Fissellier, Isabelle Girard, T. Lalu, P. Le Coz, Morgan Le Guen, Olivier Ille, Didier Leys, Christophe Magni, Éric Manchon, Mikaël Mazighi, F. Mounier‐Véhier, Marinette Moynier, Ioan-Paul Muresan, Norbert Nighoghossian, Elodie Ong, Canan Özsancak, Frédéric Philippeau, Fernando Pico, Georges Rodesch, Thierry Rosolacci, Candice Sabben, Denis Sablot, Philippe Tassan, Maya Tchikviladzé, Francis Turjman, Anne‐Evelyne Vallet, Adrien Wang, Marc Zins, Mathieu Zuber,

Stroke Rehabilitation and Recovery

Background and Purpose— Whether all acute stroke patients with large vessel occlusion need to undergo intravenous thrombolysis before mechanical thrombectomy (MT) is debated as (1) the incidence of post-thrombolysis early recanalization (ER) is still unclear; (2) thrombolysis may be harmful in patients unlikely to recanalize; and, conversely, (3) transfer for MT may be unnecessary in patients highly likely to recanalize. Here, we determined the incidence and predictors of post-thrombolysis ER in patients referred for MT and derive ER prediction scores for trial design. Methods— Registries from 4 MT-capable centers gathering patients referred for MT and thrombolyzed either on site (mothership) or in a non MT-capable center (drip-and-ship) after magnetic resonance– or computed tomography–based imaging between 2015 and 2017. ER was identified on either first angiographic run or noninvasive imaging. In the magnetic resonance imaging subsample, thrombus length was determined on T2*-based susceptibility vessel sign. Independent predictors of no-ER were identified using multivariable logistic regression models, and scores were developed according to the magnitude of regression coefficients. Similar registries from 4 additional MT-capable centers were used as validation cohort. Results— In the derivation cohort (N=633), ER incidence was ≈20%. In patients with susceptibility vessel sign (n=498), no-ER was independently predicted by long thrombus, proximal occlusion, and mothership paradigm. A 6-point score derived from these variables showed strong discriminative power for no-ER (C statistic, 0.854) and was replicated in the validation cohort (n=353; C statistic, 0.888). A second score derived from the whole sample (including negative T2* or computed tomography–based imaging) also showed good discriminative power and was similarly validated. Highest grades on both scores predicted no-ER with >90% specificity, whereas low grades did not reliably predict ER. Conclusions— The substantial ER rate underlines the benefits derived from thrombolysis in bridging populations. Both prediction scores afforded high specificity for no-ER, but not for ER, which has implications for trial design.