• Zhang, Yongwei
• Gralla, Jan
• Oostenbrugge, Robert Van V.
• Roos, Yvo
• Strbian, Daniel
• Ying, Congguo
• Zwam, Wim Van
• Guo, Changwei
• Majoie, Charles B.
• Zhongrong, Miao
• Kaesmacher, Johannes
• Mitchell, Peter J.
• Uyttenboogaart, Maarten
• Kappelhof, Manon
• Rinkel, Leon A.
• Lei, Zhang
• Yan, Bernard
• Kimura, Kazumi
• Meinel, Thomas
• Fischer, Urs M.
• Bütikofer, Lukas
• Liu, Sheng
• Seiffge, David
• Piechowiak, Eike
• Suzuki, Kentaro
• Yang, Pengfei
• Dobrocky, Tomas
• Cavalcante, Fabiano
• Lingsma, Hester
• Treurniet, Kilian
• Liu, Jianmin
• Zi, Wenjie
• Eker, Omer

Abstract

<jats:p><jats:bold>Introduction:</jats:bold>The benefit of intravenous thrombolysis for acute ischemic stroke declines with longer time from symptom onset. It is not known whether a similar time-dependent treatment effect modification of intravenous thrombolysis (IVT) is present in patients undergoing thrombectomy.</jats:p><jats:p><jats:bold>Methods:</jats:bold>Individual participant data meta-analysis from six randomized controlled trials comparing IVT plus thrombectomy vs thrombectomy alone. Primary analysis was performed testing for heterogeneity of the treatment effect. We estimated the effect of onset-to-expected-IVT times on the association between allocated treatment (intravenous thrombolysis plus thrombectomy vs thrombectomy alone) and disability at 3 months (modified Rankin scale, mRS).</jats:p><jats:p><jats:bold>Results:</jats:bold>In 2313 participants (IVT plus thrombectomy [n = 1160]; thrombectomy alone [n = 1153]; median age, 71 years, IQR 62-78 years; 44.3% female), the median onset-to-expected-IVT time was 2h 28min (IQR, 1h 46min to 3h 17min). We observed a statistically significant interaction between onset-to-expected-IVT times and treatment group effect (pinteraction=0.02), with the treatment effect of IVT plus thrombectomy vs thrombectomy alone declining over time (e.g., common adjusted Odds Ratio for a one-step mRS shift toward improvement 1.49, 95%CI 1.13-1.96 at 1h; 1.25, 95% CI 1.04-1.49 at 2h; 1.04, 95% CI 0.88-1.23 at 3h). If treated before 2h 20min after symptom onset, participants allocated to IVT plus thrombectomy were significantly less disabled at 90 days than participants allocated to thrombectomy alone.</jats:p><jats:p><jats:bold>Conclusions:</jats:bold>This individual participant data meta-analysis of patients with ischemic stroke presenting at thrombectomy-capable stroke centers demonstrated time-dependence of the treatment effect of IVT plus thrombectomy vs thrombectomy alone. Intravenous thrombolysis showed clinical benefit if it was administered within 2h 20min after symptom onset.</jats:p><jats:p><jats:graphic xmlns:xlink="http://www.w3.org/1999/xlink" orientation="portrait" position="float" xlink:href="g4929.jpg" /></jats:p>

Topics

• impedance spectroscopy
• laser emission spectroscopy
• chemical ionisation