E-109 Combined intra-venous and intra-arterial thrombolysis versus intra-venous thrombolysis alone in stroke patients underwent mechanical thrombectomy: a propensity-matched analysis
Notice bibliographique
Résumé
Introduction Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) combining intravenous (IV) or intra-arterial (IA) thrombolysis has been studied recently. However, no study has explored the outcomes of combining both IV and IA thrombolysis with MT. Methods Data from Stroke Thrombectomy and Aneurysm Registry (STAR) from 2013 to 2023 was utilized. We compared AIS patients with LVO who underwent MT and combined IVT and IAT with those who underwent MT with IVT only. We performed propensity score (PS) matching between the two groups using age, sex, premorbid mRS, admission NIHSS, occluded vessel, ASPECTS score, time from symptoms onset to arterial puncture, and frontline technique. Primary outcomes were symptomatic intracranial hemorrhage (sICH) and 90-day modified Rankin Scale (mRS) 0–2. Secondary outcomes included successful recanalization (mTICI ≥2C), early neurological improvement, any ICH, mRS 0–1, and 90-day mortality. Results A total of 2495 LVO-related AIS patients were included, consisting of the IA+IV group (n = 266) and the IV group (n = 2228). Propensity matching yielded 192 well-matched patients in each group. No significant differences were observed between the groups in either ICH or sICH (odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.61–1.52, p = 0.60; OR: 0.92, 95% CI:0.42–2.03, p > 0.90, respectively). The IA+IV group had a significantly lower proportion of successful recanalization (OR:0.41, 95% CI: 0.27–0.62, p < 0.001), and early neurological improvement (OR: 0.55, 95% CI: 0.30–1.00). However, 90-daymRS 0–2, mRS 0–1, and mortality rates showed no significant differences between the two groups. Conclusion This study suggests that the combined use of IAT and IVT in AIS patients undergoing MT is safe. Although the MT+IVT+IAT group demonstrated lower rates of recanalization and early neurological improvement, long-term functional outcomes and mortality rates were comparable to the MT+IVT group, indicating a potential delayed benefit of additional IAT therapy. Disclosures R. Abo Kasem: None. S. Elawady: None. B. Mulpur: None. H. Matsukawa: None. C. Cunningham: None. M. Sowlat: None. A. Orscelik: None. N. Nawabi: None. J. Isidor: None. I. Maier: 3; C; speakers’ honoraria from Pfizer and Bristol-Myers Squibb. P. Jabbour: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: 1; C; RMS research is supported by the NREF, Joe Niekro Foundation, Brain Aneurysm Foundation, Bee Foundation, Department of Health Biomedical Research Grant (21K02AWD-007000) and by National Institute of H. M. Psychogios: 1; C; Grants from the Swiss National Science Foundation (SNF) for the DISTAL trial (33IC30_198783) and TECNO trial (32003B_204977), Grant from Bangerter-Rhyner Stiftung for the DISTAL trial. Unrestricted Gr. E. Samaniego: 2; C; consults for Medtronic, microvention, Rapid Medical. S. Yoshimura: 6; C; received lecture fee from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics. H. Cuellar: 2; C; Consultant for Medtronic and Microvention. B. Howard: None. A. Alawieh: None. A. Alaraj: 2; C; Consultant for Cerenovus. M. Ezzeldin: 2; C; Consultant for Viz.ai and Imperative care. Investments in Galaxy Therapeutics. D. Romano: 2; C; Consultant for Penumbra, Balt, Microvention, Phenox. O. Tanweer: 2; C; Consulting Agreements: Viz.AI, Inc., Penumbra, Inc, Balt, Inc, Stryker Inc, Imperative Inc. Proctor: Microvention Inc, Medtronic Inc. Educational/Research Grants: Q’apel Inc, Steinberg Foundation. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Grandhi: 2; C; Consultant for Balt Neurovascular, Cerenovus, Medtronic Neurovascular, Rapid Medical, and Stryker Neurovascular. R. Crosa: None. C. Matouk: 2; C; Consultant for Stryker, Medtronic, Microvention, Penumbra, and Silk Road Medical. Speaker for Penumbra and Silk Road Medical. Contact PI for NIH Grant R21NS128641. M. Park: 2; C; Consultant for Medtronic. M. Levitt: 1; C; Unrestricted educational grants from Medtronic and Stryker; consulting agreement with Medtronic, Aeaean Advisers and Metis Innovative; equity interest in Proprio, Stroke Diagnostics, Apertur, Stereota. W. Brinjikji: 1; C; Holds equity in Nested Knowledge, Superior Medical Editors, Piraeus Medical, Sonoris Medical, and MIVI Neurovascular. He receives royalties from Medtronic and Balloon Guide Catheter Technology. He rec. M. Moss: None. E. Daglioglu: None. R. Williamson Jr: 2; C; Consultant for Medtronic, Stryker, and Synaptive Medical. P. Navia: 2; C; Consultant for Penumbra, Medtronic, Stryker, Cerenovus and Balt. P. Kan: 1; C; Grants from the NIH (1U18EB029353–01) and unrestricted educational grants from Medtronic and Siemens. Consultant for Imperative Care and Stryker Neurovascular. Stock ownership in Vena Medical. R. De Leacy: 1; C; PI for Imperative Trial; Research grants from Siemens Healthineers and Kaneka medical. Consultant for Cerenovus, Stryker Neurovascular and Sim & Cure. Minor equity interest Vastrax, Borvo medical, Syn. S. Chowdhry: 2; C; Consultant and proctor for Medtronic and Microvention. D. Altschul: 2; C; Consultant for MicroVention, Stryker, and Cerenovus. A. Spiotta: 2; C; Consultant for Penumbra, Terumo, RapidAI, Cerenovus. N. Goyal: None.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,003 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».