Die Wirkung von additiver systemischer Lysetherapie zur mechanischen Therapie auf das funktionelle Outcome in Schlaganfallpatient*innen mit proximalem Gefäßverschluss (LVOS) der vorderen Zirkulation

by Mostafa Badr
Doctoral thesis
Date of Examination:2024-09-11
Date of issue:2024-09-04
Advisor:Prof. Dr. Jan Liman
Referee:Prof. Dr. Jan Liman
Referee:PD Dr. Vesna Malinova
Persistent Address: http://dx.doi.org/10.53846/goediss-10707

 

 

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Abstract

English

Background: Endovascular treatment (EVT) represents a highly effective intervention for the management of large vessel occlusion stroke (LVOS). The question of whether intravenous thrombolysis (IVT) prior to endovascular treatment (EVT) is more beneficial than EVT alone remains controversial. The objective of this study was to specifically address the question of whether bridging IVT directly prior to EVT has additional positive effects on reperfusion times, successful reperfusion, and functional outcomes compared with EVT alone. Methods: The present study included patients with LVOS in the anterior circulation who were eligible for EVT, either with or without prior IVT, and who were directly admitted to endovascular centres (mothership) for inclusion in this multicentre, retrospective study. The data pertaining to the patients was derived from the German Stroke Registry, which is an open, multicentre, and prospective observational study. Outcome parameters included groin-to-reperfusion time, successful reperfusion [defined as a Thrombolysis in Cerebral Infarction (TICI) scale 2b-3], change in National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and mortality at 90 days. Results: Of the 881 included mothership patients with anterior circulation LVOS, 486 (55.2%) received bridging therapy with i.v.-rtPA prior to EVT, and 395 (44.8%) received EVT alone. Adjusted, multivariate linear mixed effect models revealed no difference in groin-to-reperfusion time between the groups (48 ± 36 vs. 49 ± 34 min; p = 0.299). Rates of successful reperfusion (TICI ≥ 2b) were higher in patients with bridging IVT (fixed effects estimate 0.410, 95% CI, 0.070; 0.750, p = 0.018). There was a trend toward a higher improvement in the NIHSS during hospitalization [ΔNIHSS: bridging-IVT group 8 (IQR, 9.8) vs. 4 (IQR 11) points in the EVT alone group; fixed effects estimate 1.370, 95% CI, −0.490; 3.240, p = 0.149]. mRS at 90 days follow-up was lower in the bridging IVT group [3 (IQR, 4) vs. 4 (IQR, 4); fixed effects estimate −0.350, 95% CI, −0.680; −0.010, p = 0.041]. There was a non-significantly lower 90 day mortality in the bridging IVT group compared with the EVT alone group (22.4% vs. 33.6%; fixed effects estimate 0.980, 95% CI −0.610; 2.580, p = 0.351). Rates of any intracerebral hemorrhage did not differ between both groups (4.1% vs. 3.8%, p = 0.864). Conclusions: This study provides evidence that bridging IVT might improve rates of successful reperfusion and long-term functional outcome in mothership patients with anterior circulation LVOS eligible for EVT.
Keywords: ischemic stroke; LVOS; bridging; endovascular treatment; rtPA
Schlagwörter: ischämischer Schlaganfall; Verschluss proximaler Arterien; endovaskuläre Behandlung; systemische Lysetherapie