TY - JOUR T1 - Benefit and risk of intravenous alteplase in patients with acute large vessel occlusion stroke and low ASPECTS JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 8 LP - 13 DO - 10.1136/neurintsurg-2021-017986 VL - 15 IS - 1 AU - Gabriel Broocks AU - Rosalie McDonough AU - Matthias Bechstein AU - Uta Hanning AU - Caspar Brekenfeld AU - Fabian Flottmann AU - Helge Kniep AU - Marie Teresa Nawka AU - Milani Deb-Chatterji AU - Götz Thomalla AU - Peter Sporns AU - Leonard LL Yeo AU - Benjamin YQ Tan AU - Anil Gopinathan AU - Andreas Kastrup AU - Maria Politi AU - Panagiotis Papanagiotou AU - Andre Kemmling AU - Jens Fiehler AU - Lukas Meyer A2 - , Y1 - 2023/01/01 UR - http://jnis.bmj.com/content/15/1/8.abstract N2 - Background The benefit of best medical treatment including intravenous alteplase (IVT) before mechanical thrombectomy (MT) in patients with acute ischemic stroke and extensive early ischemic changes on baseline CT remains uncertain. The purpose of this study was to evaluate the benefit of IVT for patients with low ASPECTS (Alberta Stroke Programme Early CT Score) compared with patients with or without MT.Methods This multicenter study pooled consecutive patients with anterior circulation acute stroke and ASPECTS≤5 to analyze the impact of IVT on functional outcome, and to compare bridging IVT with direct MT. Functional endpoints were the rates of good (modified Rankin Scale (mRS) score ≤2) and very poor (mRS ≥5) outcome at day 90. Safety endpoint was the occurrence of symptomatic intracranial hemorrhage (sICH).Results 429 patients were included. 290 (68%) received IVT and 168 (39%) underwent MT. The rate of good functional outcome was 14.4% (95% CI 7.1% to 21.8%) for patients who received bridging IVT and 24.4% (95% CI 16.5% to 32.2%) for those who underwent direct MT. The rate of sICH was significantly higher in patients with bridging IVT compared with direct MT (17.8% vs 6.4%, p=0.004). In multivariable logistic regression analysis, IVT was significantly associated with very poor outcome (OR 2.22, 95% CI 1.05 to 4.73, p=0.04) and sICH (OR 3.44, 95% CI 1.18 to 10.07, p=0.02). Successful recanalization, age, and ASPECTS were associated with good functional outcome.Conclusions Bridging IVT in patients with low ASPECTS was associated with very poor functional outcome and an increased risk of sICH. The benefit of this treatment should therefore be carefully weighed in such scenarios. Further randomized controlled trials are required to validate our findings.Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author. ER -