Universität zu Köln

Broocks, Gabriel ORCID: 0000-0002-7575-9850, Meyer, Lukas ORCID: 0000-0002-3776-638X, Kabiri, Reza, Kniep, Helge C., McDonough, Rosalie, Bechstein, Matthias, van Horn, Noel, Lindner, Thomas, Sedlacik, Jan, Cheng, Bastian, Thomalla, Goetz, Schoen, Gerhard, Fiehler, Jens, Hanning, Uta and Schoenfeld, Michael H. (2021). Impact of intravenous alteplase on sub-angiographic emboli in high-resolution diffusion-weighted imaging following successful thrombectomy. Eur. Radiol., 31 (11). S. 8228 - 8236. NEW YORK: SPRINGER. ISSN 1432-1084

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Abstract

Objective Thrombus microfragmentation causing peripheral emboli (PE) during mechanical thrombectomy (MT) may modulate treatment effects, even in cases with successful reperfusion. This study aims to investigate whether intravenous alteplase is of potential benefit in reducing PE after successful MT. Methods Patients from a prospective study treated at a tertiary care stroke center between 08/2017 and 12/2019 were analyzed. The main inclusion criterion was successful reperfusion after MT (defined as expanded thrombolysis in cerebral infarction (eTICI) scale >= 2b50) of large vessel occlusion anterior circulation stroke. All patients received a high-resolution diffusion-weighted imaging (DWI) follow-up 24 h after MT for PE detection. Patients were grouped as direct MT (no alteplase) or as MT plus additional intravenous alteplase. The number and volume of ischemic core lesions and PE were then quantified and analyzed. Results Fifty-six patients were prospectively enrolled. Additional intravenous alteplase was administered in 46.3% (26/56). There were no statistically significant differences of PE compared by groups of direct MT and additional intravenous alteplase administration regarding mean numbers (12.1, 95% CI 8.6-15.5 vs. 11.1, 95% CI 7.0-15.1; p = 0.701), and median volume (0.70 mL, IQR 0.21-1.55 vs. 0.39 mL, IQR 0.10-1.62; p = 0.554). In uni- and multivariable linear regression analysis, higher eTICI scores were significantly associated with reduced PE, while the administration of alteplase was neither associated with numbers nor volume of peripheral emboli. Additional alteplase did not alter reperfusion success. Conclusions Intravenous alteplase neither affects the number nor volume of sub-angiographic DWI-PE after successful endovascular reperfusion. In the light of currently running randomized trials, further studies are warranted to validate these findings.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Broocks, Gabriel UNSPECIFIED orcid.org/0000-0002-7575-9850 UNSPECIFIED Meyer, Lukas UNSPECIFIED orcid.org/0000-0002-3776-638X UNSPECIFIED Kabiri, Reza UNSPECIFIED UNSPECIFIED UNSPECIFIED Kniep, Helge C. UNSPECIFIED UNSPECIFIED UNSPECIFIED McDonough, Rosalie UNSPECIFIED UNSPECIFIED UNSPECIFIED Bechstein, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED van Horn, Noel UNSPECIFIED UNSPECIFIED UNSPECIFIED Lindner, Thomas UNSPECIFIED UNSPECIFIED UNSPECIFIED Sedlacik, Jan UNSPECIFIED UNSPECIFIED UNSPECIFIED Cheng, Bastian UNSPECIFIED UNSPECIFIED UNSPECIFIED Thomalla, Goetz UNSPECIFIED UNSPECIFIED UNSPECIFIED Schoen, Gerhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Fiehler, Jens UNSPECIFIED UNSPECIFIED UNSPECIFIED Hanning, Uta UNSPECIFIED UNSPECIFIED UNSPECIFIED Schoenfeld, Michael H. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-585906
DOI:	10.1007/s00330-021-07980-0
Journal or Publication Title:	Eur. Radiol.
Volume:	31
Number:	11
Page Range:	S. 8228 - 8236
Date:	2021
Publisher:	SPRINGER
Place of Publication:	NEW YORK
ISSN:	1432-1084
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ACUTE ISCHEMIC-STROKE; INDIVIDUAL PATIENT DATA; MECHANICAL THROMBECTOMY; METAANALYSIS; PROTOCOL; BRAIN; RISK Multiple languages Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/58590