TY - JOUR T1 - Effect of stroke etiology on endovascular thrombectomy with or without intravenous alteplase: a subgroup analysis of DIRECT-MT JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 1200 LP - 1206 DO - 10.1136/neurintsurg-2021-018275 VL - 14 IS - 12 AU - Pengfei Xing AU - Xiaoxi Zhang AU - Hongjian Shen AU - Fang Shen AU - Lei Zhang AU - Zifu Li AU - Yongxin Zhang AU - Bo Hong AU - Huaizhang Shi AU - Hongxing Han AU - Xiaofei Ye AU - Yongwei Zhang AU - Pengfei Yang AU - Jianmin Liu A2 - , Y1 - 2022/12/01 UR - http://jnis.bmj.com/content/14/12/1200.abstract N2 - Background Stroke etiology might influence the clinical outcomes in patients with large vessel occlusion receiving endovascular treatment (EVT) with or without thrombolysis.Objective To examine whether stroke etiology resulted in different efficacy and safety in patients treated with EVT-alone or EVT preceded by intravenous alteplase (combined therapy).Methods We assessed the efficacy and safety of treatment strategy based on prespecified stroke etiology, cardioembolism (CE), large-artery atherosclerosis (LAA), and undetermined cause (UC) for patients enrolled in the DIRECT-MT trial. The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Multivariate ordinal logistic regression analysis was used to calculate the adjusted common OR for a shift of better mRS score for EVT-alone versus combined therapy. A term was entered to test for interaction.Results In this study, 656 patients were grouped into three prespecified stroke etiologic subgroups. The adjusted common ORs for improvement in the 90-day ordinal mRS score with EVT-alone were 1.2 (95% CI 0.8 to 1.8) for CE, 1.6 (95% CI 0.8 to 3.3) for LAA, and 0.8 (95% CI 0.5 to 1.3) for UC. Compared with CE, EVT-alone was more likely to result in an mRS score of 0–1 (pinteraction=0.047) and extended Thrombolysis in Cerebral Infarction ≥2b (pinteraction=0.041) in the LAA group. The differences in mortality and symptomatic intracranial hemorrhage within 90 days were not significant between the subgroups (p>0.05).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).All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable. ER -