RT Journal Article
SR Electronic
T1 Time to treatment with bridging intravenous alteplase before endovascular treatment:subanalysis of the randomized controlled SWIFT-DIRECT trial
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP neurintsurg-2022-019207
DO 10.1136/jnis-2022-019207
A1 Thomas R Meinel
A1 Johannes Kaesmacher
A1 Lukas Buetikofer
A1 Daniel Strbian
A1 Omer Faruk Eker
A1 Christophe Cognard
A1 Pasquale Mordasini
A1 Sandro Deppeler
A1 Vitor Mendes Pereira
A1 Jean François Albucher
A1 Jean Darcourt
A1 Romain Bourcier
A1 Benoit Guillon
A1 Chrysanthi Papagiannaki
A1 Guillaume Costentin
A1 Gerli Sibolt
A1 Silja Räty
A1 Benjamin Gory
A1 Sébastien Richard
A1 Jan Liman
A1 Marielle Ernst
A1 Marion Boulanger
A1 Charlotte Barbier
A1 Laura Mechtouff
A1 Liqun Zhang
A1 Gaultier Marnat
A1 Igor Sibon
A1 Omid Nikoubashman
A1 Arno Reich
A1 Arturo Consoli
A1 David Weisenburger
A1 Manuel Requena
A1 Alvaro Garcia-Tornel
A1 Suzana Saleme
A1 Solène Moulin
A1 Paolo Pagano
A1 Guillaume Saliou
A1 Emmanuel Carrera
A1 Kevin Janot
A1 Marti Boix
A1 Raoul Pop
A1 Lucie Della Schiava
A1 Andreas Luft
A1 Michel Piotin
A1 Jean Christophe Gentric
A1 Aleksandra Pikula
A1 Waltraud Pfeilschifter
A1 Marcel Arnold
A1 Adnan Siddiqui
A1 Michael T Froehler
A1 Anthony J Furlan
A1 René Chapot
A1 Martin Wiesmann
A1 Paolo Machi
A1 Hans-Christoph Diener
A1 Zsolt Kulcsar
A1 Leo Bonati
A1 Claudio Bassetti
A1 Simon Escalard
A1 David Liebeskind
A1 Jeffrey L Saver
A1 Urs Fischer
A1 Jan Gralla
A1 ,
YR 2022
UL http://jnis.bmj.com/content/early/2022/07/28/jnis-2022-019207.abstract
AB Background We hypothesized that treatment delays might be an effect modifier regarding risks and benefits of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT).Methods We used the dataset of the SWIFT-DIRECT trial, which randomized 408 patients to IVT+MT or MT alone. Potential interactions between assignment to IVT+MT and expected time from onset-to-needle (OTN) as well as expected time from door-to-needle (DTN) were included in regression models. The primary outcome was functional independence (modified Rankin Scale (mRS) 0–2) at 3 months. Secondary outcomes included mRS shift, mortality, recanalization rates, and (symptomatic) intracranial hemorrhage at 24 hours.Results We included 408 patients (IVT+MT 207, MT 201, median age 72 years (IQR 64–81), 209 (51.2%) female). The expected median OTN and DTN were 142 min and 54 min in the IVT+MT group and 129 min and 51 min in the MT alone group. Overall, there was no significant interaction between OTN and bridging IVT assignment regarding either the functional (adjusted OR (aOR) 0.76, 95% CI 0.45 to 1.30) and safety outcomes or the recanalization rates. Analysis of in-hospital delays showed no significant interaction between DTN and bridging IVT assignment regarding the dichotomized functional outcome (aOR 0.48, 95% CI 0.14 to 1.62), but the shift and mortality analyses suggested a greater benefit of IVT when in-hospital delays were short.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: NCT03192332Data are available upon reasonable request. De-identified data, together with a data dictionary, will be made accessible after ethics clearance and upon submission of a reasonable request with a research plan to the corresponding author.