@article {van Kranendonkjnis-2022-019569, author = {Katinka R van Kranendonk and Manon Kappelhof and Agnetha A E Bruggeman and Leon A Rinkel and Kilian M Treurniet and Natalie LeCouffe and Bart J Emmer and Jonathan M Coutinho and Lennard Wolff and Wim H van Zwam and Robert J van Oostenbrugge and Aad van der Lugt and Diederik W J Dippel and Yvo B W E M Roos and Henk A Marquering and Charles B L M Majoie}, editor = {, and , and Roos, Yvo and Majoie, Charles and Treurniet, Kilian and Coutinho, Jonathan and Emmer, Bart and LeCouffe, Natalie and Kappelhof, Manon and Rinkel, Leon and Bruggeman, Agnetha and Roozenbeek, Bob and Es, Adriaan van and Ridder, Inger de and Zwam, Wim van and Worp, Bart van der and Lo, Rob and Keizer, Koos and Gons, Rob and Yo, Lonneke and Boiten, Jelis and Wijngaard, Ido van den and LycklamaNijeholt, Geert LycklamaGeert and Lycklama, Geert and Hofmeijer, Jeannette and Martens, Jasper and Schonewille, Wouter and Vos, Jan Albert and Tuladhar, Anil and Schreuder, Floris and Boogaarts, Jeroen and Jenniskens, Sjoerd and Laat, Karlijn de and Dijk, Lukas van and Hertog, Heleen den and Hasselt, Boudewijn van and Brouwers, Paul and Sturm, Emiel and Bulut, Tomas and Remmers, Michel and Norden, Anouk van and Jong, Thijs de and Rozeman, Anouk and Elgersma, Otto and Uyttenboogaart, Maarten and Bokkers, Reinoud and Tuijl, Julia van and Boukrab, Issam and Kortman, Hans and Costalat, Vincent and Arquizan, Caroline and Lemmens, Robin and Demeestere, Jelle and Desfontaines, Philippe and Brisbois, Denis and Claren{\c c}on, Fr{\'e}d{\'e}ric and Samson, Yves and Brown, Martin and White, Phil and Gregson, John and Nieboer, Daan and Dippel, Diederik and Nuland, Rick van and Lugt, Aad van der and Jacobi, Linda and Berg, Ren{\'e} van den and Beenen, Ludo and Doormaal, Pieter-Jan van and Yoo, Albert and Hammer, Bas and Roosendaal, Stefan and Meijer, Anton and Krietemeijer, Menno and Hoorn, Anouk van der and Gerrits, Dick and Oostenbrugge, Robert van and Ben Jansen, Sanne Manschot and Kerkhof, Henk and Koudstaal, Peter and Lingsma, Hester and Chalos, Vicky and Berkhemer, Olvert and Versteeg, Adriaan and Wolff, Lennard and Su, Jiahang and Tolhuisen, Manon and Voorst, Henk van and Cate, Hugo ten and Maat, Moniek de and Donse-Donkel, Samantha and Beusekom, Heleen van and Taha, Aladdin and Berg, Sophie van den and Graaf, Rob van de and Goldhoorn, Robert-Jan and Hinsenveld, Wouter and Pirson, Anne and Sondag, Lotte and Reinink, Rik and Brouwer, Josje and Collette, Sabine and Steen, Wouter van der and Sprengers, Rita and Sterrenberg, Martin and Ghannouti, Naziha El and Verheesen, Sabrina and Pellikaan, Wilma and Blauwendraat, Kitty and Drabbe, Yvonne and Meris, Joke de and Simons, Michelle and Bongenaar, Hester and Loon, Anja van and Ponjee, Eva and Eilander, Rieke and Kooij, Suze and Jong, Marieke de and Santegoets, Esther and Roodenburg, Suze and Ahee, Ayla van and Moynier, Marinette and Devroye, Annemie and Marcis, Evelyn and Iezzi, Ingrid and David, Annie and Talbi, Atika and Heiligers, Leontien and Martens, Yvonne}, title = {Hemorrhage rates in patients with acute ischemic stroke treated with intravenous alteplase and thrombectomy versus thrombectomy alone}, elocation-id = {jnis-2022-019569}, year = {2022}, doi = {10.1136/jnis-2022-019569}, publisher = {British Medical Journal Publishing Group}, abstract = {Background Intravenous alteplase treatment (IVT) for acute ischemic stroke carries a risk of intracranial hemorrhage (ICH). However, reperfusion of an occluded vessel itself may contribute to the risk of ICH. We determined whether IVT and reperfusion are associated with ICH or its volume in the Multicenter Randomized Clinical trial of Endovascular treatment for Acute ischemic stroke in the Netherlands (MR CLEAN)-NO IV trial.Methods The MR CLEAN-NO IV trial randomized patients with acute ischemic stroke due to large vessel occlusion to receive either IVT followed by endovascular treatment (EVT) or EVT alone. ICH was classified according to the Heidelberg bleeding classification on follow-up MRI or CT approximately 8 hours-7 days after stroke. Hemorrhage volume was measured with ITK-snap. Successful reperfusion was defined as extended Thrombolysis In Cerebral Infarction (eTICI) score of 2b-3. Multinomial and binary adjusted logistic regression were used to determine the association of IVT and reperfusion with ICH subtypes.Results Of 539 included patients, 173 (32\%) developed ICH and 30 suffered from symptomatic ICH (sICH) (6\%). Of the patients with ICH, 102 had hemorrhagic infarction, 47 had parenchymal hematoma, 44 had SAH, and six had other ICH. Reperfusion was associated with a decreased risk of SAH, and IVT was not associated with SAH (eTICI 2b-3: adjusted OR 0.45, 95\% CI 0.21 to 0.97; EVT without IVT: OR 1.6, 95\% CI 0.91 to 2.8). Reperfusion status and IVT were not associated with overall ICH, hemorrhage volume, and sICH (sICH: EVT without IVT, OR 0.96, 95\% CI 0.41 to 2.25; eTICI 2b-3, OR 0.49, 95\% CI 0.23 to 1.05).Conclusion Neither IVT administration before EVT nor successful reperfusion after EVT were associated with ICH, hemorrhage volume, and sICH. SAH occurred more often in patients for whom successful reperfusion was not achieved.Data are available upon reasonable request. Data are available upon reasonable request after approval by the CONTRAST data access and writing committee.}, issn = {1759-8478}, URL = {https://jnis.bmj.com/content/early/2022/11/17/jnis-2022-019569}, eprint = {https://jnis.bmj.com/content/early/2022/11/17/jnis-2022-019569.full.pdf}, journal = {Journal of NeuroInterventional Surgery} }