Acute Distal Vessel Occlusion Stroke
Conditions
Keywords
Acute, occlusion, recanalization, tenecteplase, alteplase, thrombolysis, ischemic, stroke-distal
Brief summary
The purpose of this monocentric retrospective study is to compare, in patients with acute distal vessel occlusion stroke, the early rates of successful recanalization in patients treated with Alteplase (ALT) versus Tenecteplase (TNK), based on a retrospective analysis of magnetic resonance imaging (MRI) performed early after IVT.
Detailed description
Early rates of successful recanalization (SR) of distal vessel occlusions (DVO) following intravenous thrombolysis (IVT) between alteplase (ALT) and tenecteplase (TNK) are poorly known. From March 2016 to February 2020, consecutive stroke patients hospitalized in the stroke unit of the Sud-Francilien Hospital with DVO identified on baseline MRI and suitable for IVT but not for mechanical thrombectomy will be included. In our stroke unit, patients were treated with ALT, 0.9 mg/kg from March 2016 to February 2018 and then with TNK, 0.25 mg/kg from March 2018 to December 2023. MRI was controlled 1-2 hours within IVT (MRI-2). Early recanalization was assessed on an adapted Arterial Occlusion Lesion (AOL) scale, SR being defined as AOL 2/3 scores on MRI-2. The rate reduction of thrombus length (TL) when thrombus persisted, the IVT response threshold of TL and the infarct size evolution were also assessed. In the present study, the investigators sought to compare early rates of SR between the two lytics, based on a retrospective analysis of magnetic resonance imaging (MRI) performed early after IVT.
Interventions
DRUGAlteplase (0.9mg/kg)
Intravenous thrombolysis with Alteplase (0.9 mg/kg, maximum 90 mg) with 10% of the dose given as a bolus followed by an infusion lasting 60 minutes.
Intravenous thrombolysis with Tenecteplase (0.25mg/kg, maximum 25 mg) with 100% of the dose given as a bolus.
Sponsors
Centre Hospitalier Sud Francilien
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age≥ 18 years. * Acute ischemic stroke (visible on DWI, but not visible on FLAIR) on initial MRI associated with distal arterial occlusion as defined below: * A distal occlusion of the M2 segment of the middle cerebral artery (MCA) * Occlusion (regardless of location) of a non-dominant M2 branch of the MCA * Occlusion of the M3 segment of the MCA. * Occlusion of the A2 or A3 segment of the anterior cerebral artery (ACA) * Occlusion of the P2 or P3 branch of the posterior cerebral artery (PCA). * A proximal M2-MCA or proximal P1-PCA occlusion may also be included if not eligible for mechanical thrombectomy, especially if the initial NIHSS score is low (\<5). * Distal arterial occlusion is identified by MRI either on the TOF (Time of Flight)-ARM sequence and/or on the presence of a thrombus (Susceptibility Vessel sign, SVS) on the SWAN sequence, * IVT by ALT or TNK within 4H30 after onset of symptoms, * Early brain MRI performed 1 to 2 hours after IVT (MRI n°2), * Good quality MRI (absence of motion artifact interfering with interpretation) with availability of DWI, FLAIR, TOF-MRA and SWAN sequences.
Exclusion criteria
\- Patients informed of the study who objected to the collection of their data.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Early successful recanalization rate | Between 1 and 2 hours after IVT | Early successful recanalization rate defined by an Arterial Occlusive Lesion (AOL) scale grade 2 or 3 on MRI-2 performed between 1 and 2 hours after IVT. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Early complete recanalization rate | Between 1 and 2 hours after IVT | Early complete successful recanalization rate defined by an Arterial Occlusive Lesion (AOL) scale grade 3 on MRI-2 performed between 1 and 2 hours after IVT. |
| Thrombus length change | Between 1 and 2 hours after IVT | Thrombus length (TL) was approximated by measuring the susceptibility vessel sign (SVS) on the susceptibility weight angiography (SWAN) sequence. TL were measured in the 3 spatial planes, the higher value being retained. When thrombus persisted on MRI-2, TL reduction was assessed as follows : (MRI-1 length - MRI-2 length)/MRI-1 length X 100. |
| Evolution of cerebral infarct volume | Between 1 and 2 hours after IVT | Volume of the ischemic lesion will be assessed on the diffusion-weighted imaging (DWI) sequence using an automated software (Olea software). This evolution of cerebral infarct volume will be calculated as follows : DWI MRI volume n°2 - initial DWI MRI volume. |
| Rates of early post-thrombolysis intracerebral hemorrhage | Between 1 and 2 hours after IVT | Rates of early post-thrombolysis intracerebral hemorrhage on MRI-2 (performed at 1 to 2h after IVT) according to the Heidelberg classification (Kummer et al, Stroke 2015) |
| Very early clinical modification | Between 1 and 2 hours after IVT | Very early neurological modification was assessed as follows : baseline NIHSS -NIHSS at H1. Very early clinical improvement (VENI) was defined as baseline NIHSS -NIHSS at H1. ≥4, or NIHSS H1=0. |
Countries
France
Outcome results
None listed