TY - JOUR T1 - Intracranial hemorrhage in large vessel occlusion patients receiving endovascular thrombectomy with or without intravenous alteplase: a secondary analysis of the DIRECT-MT trial JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg DO - 10.1136/jnis-2022-019021 SP - neurintsurg-2022-019021 AU - Xiaowei Hu AU - Yu Zhou AU - Johanna Ospel AU - Feirong Yao AU - Yizhi Liu AU - Hui Wang AU - Bo Li AU - Pinjing Hui AU - Pengfei Yang AU - Yongwei Zhang AU - Lei Zhang AU - Zifu Li AU - Pengfei Xing AU - Huaizhang Shi AU - Hongxing Han AU - Shouchun Wang AU - Qi Fang AU - Jianmin Liu A2 - , Y1 - 2022/10/21 UR - http://jnis.bmj.com/content/early/2022/10/21/jnis-2022-019021.abstract N2 - Background Alteplase before thrombectomy for patients with large vessel occlusion stroke raises concerns regarding an increased risk of intracranial hemorrhage (ICH), but the details of this relationship are not well understood.Methods This was a secondary analysis of the DIRECT-MT trial. ICH and its subtypes were independently reviewed and classified according to the Heidelberg Bleeding Classification. The effects of alteplase before thrombectomy on ICH and ICH subtypes occurrence were evaluated using logistic regression. Clinical and imaging characteristics that may modify these effects were exploratorily tested.Results Among 591 patients, any ICH occurred in 254 (43.0%), including hemorrhagic infarction type 1 in 12 (2.1%), hemorrhagic infarction type 2 in 127 (21.7%), parenchymal hematoma type 1 in 34 (5.8%), parenchymal hematoma type 2 in 50 (8.6%), and other hemorrhage types (3a-3c) in 24 (4.1%). Similar ICH frequencies were observed with combined alteplase and thrombectomy versus thrombectomy only (134/292 (45.9%) vs 120/299 (40.1%); OR 1.27, 95% CI 0.91 to 1.75, P=0.16), but patients treated with alteplase had a higher parenchymal hematoma rate (51/287 (17.8%) vs 33/297 (11.1%); OR 1.75, 95% CI 1.08 to 2.85, P=0.024). In the adjusted model, difference in parenchymal hematoma occurrence between groups remained significant (adjusted OR 1.71, 95% CI 1.00 to 2.92, P=0.049). Patients with history of diabetes (Pinteraction=0.048), hypertension (Pinteraction=0.02), antiplatelet therapy (Pinteraction=0.02), anticoagulation therapy (Pinteraction=0.04), and statin administration (Pinteraction=0.02) harbored a higher ICH rate when they received combination therapy.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.All data relevant to the study are included in the article or uploaded as supplementary information. ER -