Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy : Results from the INFINITY Registry

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Kaesmacher , J , Abdullayev , N , Maamari , B , Dobrocky , T , Vynckier , J , Piechowiak , E , Pop , R , Behme , D , Sporns , P B , Styczen , H , Virtanen , P , Meyer , L , Meinel , T R , Cantre , D , Kabbasch , C , Maus , V , Pekkola , J , Fischer , S , Hasiu , A , Schwarz , A , Wildgruber , M , Seiffge , D J , Langner , S , Martinez-Majander , N , Radbruch , A , Schlamann , M , Mihoc , D , Beaujeux , R , Strbian , D , Fiehler , J , Mordasini , P , Gralla , J & Fischer , U 2021 , ' Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy : Results from the INFINITY Registry ' , Journal of stroke , vol. 23 , no. 1 , pp. 91-+ . https://doi.org/10.5853/jos.2020.01788

Title: Safety and Angiographic Efficacy of Intra-Arterial Fibrinolytics as Adjunct to Mechanical Thrombectomy : Results from the INFINITY Registry
Author: Kaesmacher, Johannes; Abdullayev, Nuran; Maamari, Basel; Dobrocky, Tomas; Vynckier, Jan; Piechowiak, Eike; Pop, Raoul; Behme, Daniel; Sporns, Peter B.; Styczen, Hanna; Virtanen, Pekka; Meyer, Lukas; Meinel, Thomas R.; Cantre, Daniel; Kabbasch, Christoph; Maus, Volker; Pekkola, Johanna; Fischer, Sebastian; Hasiu, Anca; Schwarz, Alexander; Wildgruber, Moritz; Seiffge, David J.; Langner, Soenke; Martinez-Majander, Nicolas; Radbruch, Alexander; Schlamann, Marc; Mihoc, Dan; Beaujeux, Remy; Strbian, Daniel; Fiehler, Jens; Mordasini, Pasquale; Gralla, Jan; Fischer, Urs
Contributor organization: Neuroscience Center
HUS Medical Imaging Center
HUS Neurocenter
Neurologian yksikkö
Date: 2021-01
Language: eng
Number of pages: 14
Belongs to series: Journal of stroke
ISSN: 2287-6391
DOI: https://doi.org/10.5853/jos.2020.01788
URI: http://hdl.handle.net/10138/337678
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 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.
Subject: Tissue plasminogen activator
Stroke
Thrombolytic therapy
Thrombectomy
Intracranial hemorrhages
ACUTE ISCHEMIC-STROKE
INTRAVENOUS ALTEPLASE
DOUBLE-BLIND
MULTICENTER
THROMBOLYSIS
METAANALYSIS
MANAGEMENT
THERAPY
3112 Neurosciences
3124 Neurology and psychiatry
3121 General medicine, internal medicine and other clinical medicine
Peer reviewed: Yes
Rights: cc_by_nc
Usage restriction: openAccess
Self-archived version: publishedVersion


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