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Intracranial hemorrhage in large vessel occlusion patients receiving endovascular thrombectomy with or without intravenous alteplase: a secondary analysis of the DIRECT-MT trial
Conclusions Our data showed that in the DIRECT-MT trial, alteplase did not increase overall ICH for large vessel occlusion patients treated with thrombectomy, but it increased the parenchymal hematoma rate.
Source: Journal of NeuroInterventional Surgery - September 15, 2023 Category: Neurosurgery Authors: Hu, X., Zhou, Y., Ospel, J., Yao, F., Liu, Y., Wang, H., Li, B., Hui, P., Yang, P., Zhang, Y., Zhang, L., Li, Z., Xing, P., Shi, H., Han, H., Wang, S., Fang, Q., Liu, J., for the Direct-MT investigators Tags: Open access, Ischemic stroke Source Type: research

Influence of time metrics on the treatment effect of intravenous alteplase prior to endovascular treatment in MR CLEAN-NO IV
Conclusion In MR CLEAN-NO IV, the effect of IVT prior to EVT was not modified by OTR, OTN, DTG or NTG times. Our results do not support the use of these metrics to guide IVT treatment decisions prior to EVT in comprehensive stroke centres. Trial registration number ISRCTN80619088.
Source: Journal of NeuroInterventional Surgery - August 29, 2023 Category: Neurosurgery Authors: Rinkel, L. A., Treurniet, K. M., Kappelhof, M., LeCouffe, N. E., Bruggeman, A. A. E., Nieboer, D., van Zwam, W. H., Uyttenboogaart, M., Dippel, D. W. J., Emmer, B. J., Roos, Y. B. W. E. M., Majoie, C. B. L. M., Coutinho, J. M., on behalf of the MR CLEAN-N Tags: Ischemic stroke Source Type: research

Time to treatment with bridging intravenous alteplase before endovascular treatment:subanalysis of the randomized controlled SWIFT-DIRECT trial
Conclusions We found no evidence that the effect of bridging IVT on functional independence is modified by overall or in-hospital treatment delays. Considering its low power, this subgroup analysis could have missed a clinically important effect, and exploratory analysis of secondary clinical outcomes indicated a potentially favorable effect of IVT with shorter in-hospital delays. Heterogeneity of the IVT effect size before MT should be further analyzed in individual patient meta-analysis of comparable trials. Trial registration number URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03192332
Source: Journal of NeuroInterventional Surgery - August 29, 2023 Category: Neurosurgery Authors: Meinel, T. R., Kaesmacher, J., Buetikofer, L., Strbian, D., Eker, O. F., Cognard, C., Mordasini, P., Deppeler, S., Mendes Pereira, V., Albucher, J. F., Darcourt, J., Bourcier, R., Guillon, B., Papagiannaki, C., Costentin, G., Sibolt, G., Räty, S., Tags: Open access, Ischemic stroke Source Type: research

E-189 Outcomes of tenecteplase versus alteplase after mechanical thrombectomy in a multiethnic stroke consortium registry
ConclusionIn this prospective, multi-center stroke consortium study, IV TNK in comparison to tPA prior to MT for ischemic stroke resulted in non-inferior outcomes related to angiographic reperfusion and functional status at discharge. These findings compliment the current literature and include a large Hispanic US cohort. Further analysis will include expansion of contributing centers and use of propensity scoring.Abstract E-189 Table 1 and 2Disclosures M. Gaub: None. D. Ramaswamy: None. A. Cardentey: None. S. Bandela: None. G. Gealogo: None. J. Mascitelli: None. F. Al Saiegh: None. L. Birnbaum: 2; C; Rapid AI, Imperative Care.
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Gaub, M., Ramaswamy, D., Cardentey, A., Bandela, S., Gealogo, G., Mascitelli, J., Al Saiegh, F., Birnbaum, L. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

O-035 Endovascular treatment of cerebral venous thrombosis involving the deep venous system
ConclusionsAlthough deep venous involvement of CVT is uncommon, these patients are at risk of quickly becoming critically ill with an elevated rate of death or dependency. Although these patients may develop stroke, hemorrhage, or neurologic decline prompting consideration of endovascular therapy, the deep cerebral venous system is not easily accessible with catheters due to small lumens and risk of perforation. It has been proposed that deep cerebral veins may have a higher chance of recanalization if venous thrombus burden is reduced in other parts of the dural venous sinuses. Current literature has not fully explored th...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Morel, B., Hoffman, J., Folzenlogen, Z., Roark, C., Seinfeld, J., Case, D. Tags: SNIS 20th annual meeting oral abstracts Source Type: research

P-009 Reperfusion injury after endovascular thrombectomy may be related to pre-treatment infarct topography
ConclusionsGreater basal ganglia infarct volume was associated with a higher risk of HT when accounting for infarct volumes in other regions. Susceptibility vessel sign was associated with basal ganglia infarct volume, which may be related to acute middle cerebral artery perforator occlusion.Disclosures R. Regenhardt: 1; C; National Institutes of Health, Society of Vascular and Interventional Neurology, Heitman Stroke Foundation. 6; C; DSMB for Rapid Medical. A. Bonkhoff: None. M. Schirmer: None. A. Das: None. A. Dmytriw: None. J. Vranic: None. R. Gupta: None. J. Hirsch: None. J. Rabinov: None. C. Stapleton: None. T. Lesli...
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Regenhardt, R., Bonkhoff, A., Schirmer, M., Das, A., Dmytriw, A., Vranic, J., Gupta, R., Hirsch, J., Rabinov, J., Stapleton, C., Leslie-Mazwi, T., Patel, A., Rost, N. Tags: SNIS 20th annual meeting oral poster abstracts Source Type: research

E-006 U.S. health care system-wide transition from alteplase to tenecteplase before mechanical thrombectomy: functional outcomes, early reperfusion rates, intracranial bleeding and femoral access site complications
ConclusionsThe first-year experience demonstrates the effectiveness and safety of the transitioning from TPA to TNK. The higher early recanalization rates with TNK are striking. Additional studies are required to investigate whether TNK is superior to TPA in the setting of LVO stroke.Disclosures M. Collins: None. C. Schirmer: None. G. Weiner: None. O. Goren: None. I. Melamed: None. S. Dalal: None. M. Kole: None. A. Noto: None. P. Hendrix: None.
Source: Journal of NeuroInterventional Surgery - July 30, 2023 Category: Neurosurgery Authors: Collins, M., Schirmer, C., Weiner, G., Goren, O., Melamed, I., Dalal, S., Kole, M., Noto, A., Hendrix, P. Tags: SNIS 20th annual meeting electronic poster abstracts Source Type: research

Early recanalization with intravenous thrombolysis before mechanical thrombectomy: considerations to explore with tenecteplase
Time is brain. Hence, timely reperfusion in emergent large vessel occlusion (LVO) stroke is critical for favorable outcomes. Intravenous thrombolysis with alteplase (TPA) before mechanical thrombectomy (MT) for emergent LVO stroke is associated with significantly higher rates of preinterventional reperfusion than MT alone. Recent post hoc analyses of SWIFT-DIRECT and DIRECT-MT have shown that times longer than 30 min since TPA administration are associated with increased reperfusion rates.1 2 The incremental increase of reperfusion rates with longer times since TPA administration underpins TPA’s time dependence to ex...
Source: Journal of NeuroInterventional Surgery - April 13, 2023 Category: Neurosurgery Authors: Hendrix, P., Schirmer, C. M. Tags: Letter Source Type: research

Perceived acceptable uncertainty regarding comparability of endovascular treatment alone versus intravenous thrombolysis plus endovascular treatment
Conclusion Physicians would generally feel comfortable skipping IVT before EVT at different certainty thresholds. Most physicians would treat with EVT alone if randomized trial data suggested that the number of patients achieving functional independence at 90 days was similar between the two groups, and one could be sufficiently sure that no more than 3 out of 100 patients would not achieve functional independence at 90 days due to skipping IVT.
Source: Journal of NeuroInterventional Surgery - February 14, 2023 Category: Neurosurgery Authors: Kaesmacher, J., Mujanovic, A., Treurniet, K., Kappelhof, M., Meinel, T. R., Yang, P., Liu, J., Zhang, Y., Zi, W., Yang, Q., Nogueira, R. G., Kimura, K., Matsumaru, Y., Suzuki, K., Yan, B., Mitchell, P. J., Miao, Z., Roos, Y. B. W. E. M., Majoie, C. B. L. Tags: Open access, Ischemic stroke Source Type: research

Benefit and risk of intravenous alteplase in patients with acute large vessel occlusion stroke and low ASPECTS
Conclusions Bridging IVT in patients with low ASPECTS was associated with very poor functional outcome and an increased risk of sICH. The benefit of this treatment should therefore be carefully weighed in such scenarios. Further randomized controlled trials are required to validate our findings.
Source: Journal of NeuroInterventional Surgery - December 14, 2022 Category: Neurosurgery Authors: Broocks, G., McDonough, R., Bechstein, M., Hanning, U., Brekenfeld, C., Flottmann, F., Kniep, H., Nawka, M. T., Deb-Chatterji, M., Thomalla, G., Sporns, P., Yeo, L. L., Tan, B. Y., Gopinathan, A., Kastrup, A., Politi, M., Papanagiotou, P., Kemmling, A., F Tags: Open access, Editor''s choice, Ischemic stroke Source Type: research

Economic evaluation of intravenous alteplase for stroke with the time of onset between 4.5 and 9 hours
Conclusion For patients with AIS with a time of onset between 4.5 and 9 hours, perfusion imaging-guided intravenous alteplase was likely to be cost-effective in China and was cost-effective in the US when compared with placebo.
Source: Journal of NeuroInterventional Surgery - December 14, 2022 Category: Neurosurgery Authors: Chen, J., Liang, X., Tong, X., Han, M., Ji, L., Zhao, S., Hu, Z., Liu, A. Tags: Open access, Socioeconomics Source Type: research

Effect of stroke etiology on endovascular thrombectomy with or without intravenous alteplase: a subgroup analysis of DIRECT-MT
Conclusions The results did not support the hypothesis that a specific treatment strategy based on stroke etiology should be used for patients with large vessel occlusion (NCT03469206).
Source: Journal of NeuroInterventional Surgery - November 14, 2022 Category: Neurosurgery Authors: Xing, P., Zhang, X., Shen, H., Shen, F., Zhang, L., Li, Z., Zhang, Y., Hong, B., Shi, H., Han, H., Ye, X., Zhang, Y., Yang, P., Liu, J., On behalf of the DIRECT-MT investigators Tags: Vascular neurology Source Type: research

Intravenous alteplase has different effects on the efficacy of aspiration and stent retriever thrombectomy: analysis of the COMPASS trial
Conclusions Prior administration of IV alteplase may adversely affect the efficacy of aspiration, but does not seem to influence the stent retriever first approach to MT in patients with anterior circulation ELVO.
Source: Journal of NeuroInterventional Surgery - September 14, 2022 Category: Neurosurgery Authors: Mokin, M., Waqas, M., Fifi, J. T., De Leacy, R., Fiorella, D., Levy, E. I., Snyder, K., Hanel, R. A., Woodward, K., Chaudry, I., Rai, A. T., Frei, D., Delgado Almandoz, J. E., Kelly, M., Arthur, A. S., Baxter, B. W., English, J., Linfante, I., Fargen, K. Tags: Ischemic stroke Source Type: research

P91 Direct thrombectomy versus intravenous bridging - the benefit of alteplase depends on ASPECTS
ConclusionASPECTS was the only baseline variable that showed a significant interaction with IVT for outcome prediction. The application of IVT in patients with an ASPECTS of <6 might have detrimental effects on outcome and may only be considered carefully.ReferencesChandra RV, Leslie-Mazwi TM, Mehta BP, et al. Does the Use of IV TPA in the Current Era of Rapid and Predictable Recanalization by Mechanical Embolectomy Represent Good Value? J Neurointerv Surg 2016 May;8(5):443–6.Turc G, Tsivgoulis G, Audebert HJ, et al. European Stroke Organisation (ESO)-European Society for Minimally Invasive Neurological Therapy (E...
Source: Journal of NeuroInterventional Surgery - August 29, 2022 Category: Neurosurgery Authors: Broocks, G., Meyer, L., Bechstein, M., Kemmling, A., Hanning, U., Fiehler, J., Faizy, T. Tags: 14th Congress of the European Society of Minimally Invasive Neurological Therapy 2022 Meeting Abstracts Source Type: research

LB002 Long term effect of field triage on times to endovascular treatment for emergent large vessel occlusion
ConclusionsComparing adjacent states over time, the implementation of severity-based field triage significantly reduced time to EVT and improved clinical outcomes.Disclosures M. Jayaraman: None. G. Baird: None. K. Ouediat: None. G. Paolucci: None. R. Haas: None. R. Torabi: None. K. Moldovan: None. J. Rhodes: None. J. Potvin: None. N. Alexander-Scott: None. S. Yaghi: None. T. Madsen: None. K. Furie: None. R. McTaggart: None.
Source: Journal of NeuroInterventional Surgery - July 26, 2022 Category: Neurosurgery Authors: Jayaraman, M., Baird, G., Ouediat, K., Paolucci, G., Haas, R., Torabi, R., Moldovan, K., Rhodes, J., Potvin, J., Alexander-Scott, N., Yaghi, S., Madsen, T., Furie, K., McTaggart, R. Tags: SNIS 19th annual meeting late-breaking oral abstracts Source Type: research

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