Abstract
Purpose: Intravenous alteplase (IVT) prior to endovascular treatment (EVT) is neither superior nor noninferior to EVT alone in acute ischemic stroke patients. We aim to assess whether the effect of IVT prior to EVT differs according to CT perfusion (CTP)–based imaging parameters. Methods: In this retrospective post hoc analysis, we included patients from the MR CLEAN-NO IV with available CTP data. CTP data were processed using syngo.via (version VB40). We performed multivariable logistic regression to obtain the effect size estimates (adjusted common odds ratio a[c]OR) on 90-day functional outcome (modified Rankin Scale [mRS]) and functional independence (mRS 0-2) for CTP parameters with two-way multiplicative interaction terms between IVT administration and the studied parameters. Results: In 227 patients, median CTP-estimated core volume was 13 (IQR 5–35) mL. The treatment effect of IVT prior to EVT on outcome was not altered by CTP-estimated ischemic core volume, penumbral volume, mismatch ratio, and presence of a target mismatch profile. None of the CTP parameters was significantly associated with functional outcome after adjusting for confounders. Conclusion: In directly admitted patients with limited CTP-estimated ischemic core volumes who presented within 4.5 h after symptom onset, CTP parameters did not statistically significantly alter the treatment effect of IVT prior to EVT. Further studies are needed to confirm these results in patients with larger core volumes and more unfavorable baseline perfusion profiles on CTP imaging.
| Original language | English |
|---|---|
| Pages (from-to) | 1053-1061 |
| Number of pages | 9 |
| Journal | Neuroradiology |
| Volume | 65 |
| Issue number | 6 |
| Early online date | 8 Mar 2023 |
| DOIs | |
| Publication status | Published - Jun 2023 |
Bibliographical note
Funding Information:The MR CLEAN-NO IV trial was part of the Collaboration for New Treatments of Acute Stroke (CONTRAST) consortium. The CONTRAST consortium acknowledges the support from the Netherlands Cardiovascular Research Initiative, an initiative of the Dutch Heart Foundation (CVON2015-01: CONTRAST), and from the Brain Foundation Netherlands (HA2015.01.06). The collaboration project is additionally financed by the Ministry of Economic Affairs by means of the PPP Allowance made available by the Top Sector Life Sciences & Health to stimulate public-private partnerships (LSHM17016). This work was funded in part through unrestricted funding by Stryker, Medtronic, and Cerenovus. The funding sources were not involved in study design, monitoring, data collection, statistical analyses, interpretation of results, or manuscript writing.
Funding Information:
BJE reports grants from LtC (ZonMW and TKI-PPP of Health Holland) outside the submitted work. CBLMM reports grants from CVON/Dutch Heart Foundation and Stryker (related) and TWIN Foundation, European Commission and Health Evaluation Netherlands, outside the submitted work, all paid to institution, and is (minority interest) shareholder of Nicolab. YBWEM reports grants from the Dutch Heart Foundation, Brain Foundation Netherlands, and Stryker outside the submitted work (paid to institution) and is shareholder of Nicolab. AL reports grants from Dutch Heart Foundation, the Brain Foundation Netherlands, Health-Holland, Stryker, Medtronic, Penumbra, Cerenovus, Siemens Healthineers, Philips Healthcare, and GE Healthcare, all paid to institution. HAM is co-founder and shareholder of Nicolab. All other contributors report no conflicts of interest.
Publisher Copyright:
© 2023, The Author(s).