Effect of Bridging Thrombolysis on the Efficacy of Stent Retriever Thrombectomy Techniques : Insights from the SWIFT-DIRECT trial.

IF 2.8 3区 医学 Q2 Medicine
Clinical Neuroradiology Pub Date : 2024-03-01 Epub Date: 2023-08-28 DOI:10.1007/s00062-023-01340-9
Raoul Pop, Silja Räty, Roberto Riva, Gaultier Marnat, Tomas Dobrocky, Pierre Louis Alexandre, Margaux Lefebvre, Jean Francois Albucher, Marion Boulanger, Federico Di Maria, Sébastien Richard, Sébastien Soize, Eike Immo Piechowiak, Jan Liman, Arno Reich, Marc Ribo, Thomas Meinel, Anastasios Mpotsaris, David S Liebeskind, Jan Gralla, Urs Fischer, Johannes Kaesmacher
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引用次数: 0

Abstract

Background: There are little available data regarding the influence of intravenous thrombolysis (IVT) on the efficacy of different first line endovascular treatment (EVT) techniques.

Methods: We used the dataset of the SWIFT-DIRECT trial which randomized 408 patients to IVT + EVT or EVT alone at 48 international sites. The protocol required the use of a stent retriever (SR), but concomitant use of a balloon guide catheter (BGC) and/or distal aspiration (DA) catheter was left to the discretion of the operators. Four first line techniques were applied in the study population: SR, SR + BGC, SR + DA, SR + DA + BGC. To assess whether the effect of allocation to IVT + EVT versus EVT alone was modified by the first line technique, interaction models were fitted for predefined outcomes. The primary outcome was first pass mTICI 2c‑3 reperfusion (FPR).

Results: This study included 385 patients of whom 172 were treated with SR + DA, 121 with SR + DA + BGC, 57 with SR + BGC and 35 with SR. There was no evidence that the effect of IVT + EVT versus EVT alone would be modified by the choice of first line technique; however, allocation to IVT + EVT increased the odds of FPR by a factor of 1.68 (95% confidence interval, CI 1.11-2.54).

Conclusion: This post hoc analysis does not suggest treatment effect heterogeneity of IVT + EVT vs EVT alone in different stent retriever techniques but provides evidence for increased FPR if bridging IVT is administered before stent retriever thrombectomy.

Abstract Image

桥接溶栓对支架取栓技术疗效的影响:SWIFT-DIRECT 试验的启示。
背景:关于静脉溶栓(IVT)对不同一线血管内治疗(EVT)技术疗效的影响,现有数据很少:我们使用了 SWIFT-DIRECT 试验的数据集,该试验在 48 个国际研究机构对 408 名患者随机进行了 IVT + EVT 或单独 EVT 治疗。试验方案要求使用支架回吸管(SR),但同时使用球囊导引导管(BGC)和/或远端抽吸导管(DA)则由操作者自行决定。研究对象采用了四种一线技术:SR、SR + BGC、SR + DA、SR + DA + BGC。为了评估IVT+EVT与单纯EVT的分配效果是否会因一线技术的不同而有所改变,我们对预定结果拟合了交互模型。主要结果是首次通过 mTICI 2c-3 再灌注(FPR):这项研究包括 385 名患者,其中 172 人接受了 SR + DA 治疗,121 人接受了 SR + DA + BGC 治疗,57 人接受了 SR + BGC 治疗,35 人接受了 SR 治疗。没有证据表明,IVT + EVT 与单独 EVT 的效果会因一线技术的选择而改变;但是,分配到 IVT + EVT 会使 FPR 的几率增加 1.68 倍(95% 置信区间,CI 1.11-2.54):这项事后分析并未表明在不同的支架取栓技术中,IVT + EVT 与单独 EVT 的治疗效果存在异质性,但提供了证据表明,如果在支架取栓术前进行桥接 IVT,FPR 会增加。
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来源期刊
Clinical Neuroradiology
Clinical Neuroradiology Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
4.90
自引率
3.60%
发文量
0
期刊介绍: Clinical Neuroradiology provides current information, original contributions, and reviews in the field of neuroradiology. An interdisciplinary approach is accomplished by diagnostic and therapeutic contributions related to associated subjects. The international coverage and relevance of the journal is underlined by its being the official journal of the German, Swiss, and Austrian Societies of Neuroradiology.
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