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Article Dans Une Revue Stroke Année : 2018

Post-Thrombolysis Recanalization in Stroke Referrals for Thrombectomy

Pierre Seners (1, 2) , Guillaume Turc (1, 2) , Olivier Naggara (1, 2) , Hilde Hénon (3) , Michel Piotin (4) , Caroline Arquizan (5) , Tae-Hee Cho (6) , Ana-Paula Narata (7) , Bertrand Lapergue (8) , Sébastien Richard (9) , Laurence Legrand (1, 2) , Nicolas Bricout (10) , Raphaël Blanc (4) , Cyril Dargazanli (11) , Benjamin Gory (12, 13) , Séverine Debiais (14) , Marie Tisserand (8) , Serge Bracard (12, 13) , Xavier Leclerc (10) , Michael Obadia (4) , Vincent Costalat (11, 15) , Lise-Prune Berner (16) , Jean-Philippe Cottier (7) , Arturo Consoli (8) , Xavier Ducrocq (17) , Jean-Louis Mas (1, 2) , Catherine Oppenheim (1, 2) , Jean-Claude Baron (1, 2) , Marie Abrivard , Sonia Alamowitch , Wagih Ben Hassen , Yves Berthezène , Karine Blanc-Lasserre , Anne Boulin , Grégoire Boulouis , Stephane Bouly , Frédéric Bourdain , David Calvet , Vladimir Charron , Mohamed Chbicheb , Stéphanie Condette-Auliac , Ovide Corabianu , Charlotte Cordonnier , Oguzhan Coskun , Thomas de Broucker , Jean-Pierre Decroix , Federico Di Maria , Serge Evrard , Mathieu Fissellier , Isabelle Girard , Thibault Lalu , Patrick Le Coz , Morgan Le Guen , Olivier Ille , Didier Leys , Christophe Magni , Eric Manchon , Mikael Mazighi , François Mounier-Vehier , Marinette Moynier , Ioan-Paul Muresan , Norbert Nighoghossian , Elodie Ong , Canan Ozsancak , Frédéric Philippeau , Fernando Pico , Georges Rodesch , Thierry Rosolacci , Candice Sabben , Denis Sablot , Philippe Tassan , Maya Tchikviladze , Francis Turjman , Anne-Evelyne Vallet , Adrien Wang , Marc Zins , Mathieu Zuber
Tae-Hee Cho
  • Fonction : Auteur
  • PersonId : 918240
Sébastien Richard
  • Fonction : Auteur
  • PersonId : 845623
Nicolas Bricout
Arturo Consoli
Xavier Ducrocq
  • Fonction : Auteur
  • PersonId : 762030
  • IdRef : 071518347
Marie Abrivard
  • Fonction : Collaborateur
Sonia Alamowitch
  • Fonction : Collaborateur
Wagih Ben Hassen
Yves Berthezène
Karine Blanc-Lasserre
  • Fonction : Collaborateur
Anne Boulin
  • Fonction : Collaborateur
Grégoire Boulouis
Stephane Bouly
  • Fonction : Collaborateur
Frédéric Bourdain
  • Fonction : Collaborateur
David Calvet
  • Fonction : Collaborateur
Vladimir Charron
  • Fonction : Collaborateur
Mohamed Chbicheb
  • Fonction : Collaborateur
Stéphanie Condette-Auliac
  • Fonction : Collaborateur
Ovide Corabianu
  • Fonction : Collaborateur
Charlotte Cordonnier
  • Fonction : Collaborateur
Oguzhan Coskun
  • Fonction : Collaborateur
Thomas de Broucker
  • Fonction : Collaborateur
Jean-Pierre Decroix
  • Fonction : Collaborateur
Federico Di Maria
  • Fonction : Collaborateur
Serge Evrard
  • Fonction : Collaborateur
  • PersonId : 906555
Mathieu Fissellier
  • Fonction : Collaborateur
Isabelle Girard
  • Fonction : Collaborateur
Thibault Lalu
  • Fonction : Collaborateur
Patrick Le Coz
  • Fonction : Collaborateur
Morgan Le Guen
  • Fonction : Collaborateur
Olivier Ille
  • Fonction : Collaborateur
Didier Leys
  • Fonction : Collaborateur
  • PersonId : 1006712
Christophe Magni
  • Fonction : Collaborateur
Eric Manchon
  • Fonction : Collaborateur
Mikael Mazighi
François Mounier-Vehier
  • Fonction : Collaborateur
Marinette Moynier
  • Fonction : Collaborateur
Ioan-Paul Muresan
  • Fonction : Collaborateur
Norbert Nighoghossian
  • Fonction : Collaborateur
  • PersonId : 918239
Elodie Ong
Canan Ozsancak
  • Fonction : Collaborateur
Frédéric Philippeau
  • Fonction : Collaborateur
Fernando Pico
  • Fonction : Collaborateur
Georges Rodesch
  • Fonction : Collaborateur
Thierry Rosolacci
  • Fonction : Collaborateur
Candice Sabben
  • Fonction : Collaborateur
Denis Sablot
  • Fonction : Collaborateur
Philippe Tassan
  • Fonction : Collaborateur
Maya Tchikviladze
  • Fonction : Collaborateur
Francis Turjman
  • Fonction : Collaborateur
Anne-Evelyne Vallet
  • Fonction : Collaborateur
Adrien Wang
  • Fonction : Collaborateur
Marc Zins
Mathieu Zuber
  • Fonction : Collaborateur

Résumé

Background and Purpose—Whether all acute stroke patients with large vessel occlusion need to undergo intravenous thrombolysis before mechanical thrombectomy (MT) is debated as (1) the incidence of post-thrombolysis early recanalization (ER) is still unclear; (2) thrombolysis may be harmful in patients unlikely to recanalize; and, conversely, (3) transfer for MT may be unnecessary in patients highly likely to recanalize. Here, we determined the incidence and predictors of post-thrombolysis ER in patients referred for MT and derive ER prediction scores for trial design. Methods—Registries from 4 MT-capable centers gathering patients referred for MT and thrombolyzed either on site (mothership) or in a non MT-capable center (drip-and-ship) after magnetic resonance– or computed tomography–based imaging between 2015 and 2017. ER was identified on either first angiographic run or noninvasive imaging. In the magnetic resonance imaging subsample, thrombus length was determined on T2*-based susceptibility vessel sign. Independent predictors of no- ER were identified using multivariable logistic regression models, and scores were developed according to the magnitude of regression coefficients. Similar registries from 4 additional MT-capable centers were used as validation cohort. Results—In the derivation cohort (N=633), ER incidence was ≈20%. In patients with susceptibility vessel sign (n=498), no-ER was independently predicted by long thrombus, proximal occlusion, and mothership paradigm. A 6-point score derived from these variables showed strong discriminative power for no-ER (C statistic, 0.854) and was replicated in the validation cohort (n=353; C statistic, 0.888). A second score derived from the whole sample (including negative T2* or computed tomography–based imaging) also showed good discriminative power and was similarly validated. Highest grades on both scores predicted no-ER with >90% specificity, whereas low grades did not reliably predict ER. Conclusions—The substantial ER rate underlines the benefits derived from thrombolysis in bridging populations. Both prediction scores afforded high specificity for no-ER, but not for ER, which has implications for trial design.

Dates et versions

hal-02306845 , version 1 (07-10-2019)

Identifiants

Citer

Pierre Seners, Guillaume Turc, Olivier Naggara, Hilde Hénon, Michel Piotin, et al.. Post-Thrombolysis Recanalization in Stroke Referrals for Thrombectomy. Stroke, 2018, 49 (12), pp.2975-2982. ⟨10.1161/STROKEAHA.118.022335⟩. ⟨hal-02306845⟩
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