Kaesmacher, Johannes, Abdullayev, Nuran ORCID: 0000-0003-4522-537X, Maamari, Basel, Dobrocky, Tomas, Vynckier, Jan, Piechowiak, Eike, I, Pop, Raoul ORCID: 0000-0003-4417-1496, Behme, Daniel, Sporns, Peter B., Styczen, Hanna, Virtanen, Pekka, Meyer, Lukas ORCID: 0000-0002-3776-638X, Meinel, Thomas R., Cantre, Daniel, Kabbasch, Christoph, Maus, Volker, Pekkola, Johanna, Fischer, Sebastian, Hasiu, Anca, Schwarz, Alexander, Wildgruber, Moritz, Seiffge, David J., Langner, Soenke ORCID: 0000-0001-7241-1173, Martinez-Majander, Nicolas, Radbruch, Alexander ORCID: 0000-0001-6238-6525, Schlamann, Marc, Mihoc, Dan, Beaujeux, Remy, Strbian, Daniel, Fiehler, Jens, Mordasini, Pasquale, Gralla, Jan and Fischer, Urs (2021). Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy: Results from the INFINITY Registry. J. Stroke, 23 (1). S. 91 - 105. SEOUL: KOREAN STROKE SOC. ISSN 2287-6405

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Abstract

Background and Purpose Data on safety and efficacy of intra-arterial (IA) fibrinolytics as adjunct to mechanical thrombectomy (MT) are sparse. Methods INtra-arterial FIbriNolytics In ThrombectomY (INFINITY) is a retrospective multi-center observational registry of consecutive patients with anterior circulation large-vessel occlusion ischemic stroke treated with MT and adjunctive administration of IA fibrinolytics (alteplase [tissue plasminogen activator, tPA] or urokinase [UK]) at 10 European centers. Primary outcome was the occurrence of symptomatic intracranial hemorrhage (sICH) according to the European Cooperative Acute Stroke Study II definition. Secondary outcomes were mortality and modified Rankin Scale (mRS) scores at 3 months. Results Of 5,612 patients screened, 311 (median age, 74 years; 44.1% female) received additional IA after or during MT (194 MT+IA tPA, 117 MT+IA UK). IA fibrinolytics were mostly administered for rescue of thrombolysis in cerebral infarction (TICI) 0-2b after MT (80.4%, 250/311). sICH occurred in 27 of 308 patients (8.8%), with an increased risk in patients with initial TICI0/1 (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.1 to 5.0 per TICI grade decrease) or in those with intracranial internal carotid artery occlusions (aOR, 3.7; 95% CI, 1.2 to 12.5). In patients with attempted rescue of TICI0-2b and available angiographic follow-up, 116 of 228 patients (50.9%) showed any angiographic reperfusion improvement after IA fibrinolytics, which was associated with mRS <= 2 (aOR, 3.1; 95% CI, 1.4 to 6.9). Conclusions Administration of IA fibrinolytics as adjunct to MT is performed rarely, but can improve reperfusion, which is associated with better outcomes. Despite a selection bias, an increased risk of sICH seems possible, which underlines the importance of careful patient selection.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Kaesmacher, JohannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Abdullayev, NuranUNSPECIFIEDorcid.org/0000-0003-4522-537XUNSPECIFIED
Maamari, BaselUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dobrocky, TomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Vynckier, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Piechowiak, Eike, IUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pop, RaoulUNSPECIFIEDorcid.org/0000-0003-4417-1496UNSPECIFIED
Behme, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Sporns, Peter B.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Styczen, HannaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Virtanen, PekkaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Meyer, LukasUNSPECIFIEDorcid.org/0000-0002-3776-638XUNSPECIFIED
Meinel, Thomas R.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cantre, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kabbasch, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Maus, VolkerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pekkola, JohannaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fischer, SebastianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hasiu, AncaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwarz, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wildgruber, MoritzUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Seiffge, David J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Langner, SoenkeUNSPECIFIEDorcid.org/0000-0001-7241-1173UNSPECIFIED
Martinez-Majander, NicolasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Radbruch, AlexanderUNSPECIFIEDorcid.org/0000-0001-6238-6525UNSPECIFIED
Schlamann, MarcUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mihoc, DanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Beaujeux, RemyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Strbian, DanielUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fiehler, JensUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mordasini, PasqualeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gralla, JanUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Fischer, UrsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-603428
DOI: 10.5853/jos.2020.01788
Journal or Publication Title: J. Stroke
Volume: 23
Number: 1
Page Range: S. 91 - 105
Date: 2021
Publisher: KOREAN STROKE SOC
Place of Publication: SEOUL
ISSN: 2287-6405
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ACUTE ISCHEMIC-STROKE; INTRAVENOUS ALTEPLASE; DOUBLE-BLIND; MULTICENTER; THROMBOLYSIS; METAANALYSIS; MANAGEMENT; THERAPYMultiple languages
Clinical Neurology; Peripheral Vascular DiseaseMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/60342

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