Article Figures & Data
- Figure 1
Flowchart of included patients. IA, intra-arterial; MR CLEAN, Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands; M3, middle cerebral artery, third segment; M4, middle cerebral artery, fourth segment; mRS, modified Rankin Scale; n, number. aEndovascularly was defined as arterial puncture in the angiography suite.
- Figure 2
Distribution on the modified Rankin Scale. IA, intra-arterial; mRS, modified Rankin Scale.
- Table 1
Baseline characteristics
Characteristics IA thrombolytics (n=95) No IA thrombolytics (n=2168) P value Age, median (IQR), years 67 (56–76) 71 (60–79) 0.02 Male, n (%) 50/95 (53) 1186/2168 (55) 0.69 Medical history, n (%) Atrial fibrillation 14/95 (14.7) 491/2139 (23.0) 0.06 Diabetes mellitus 10/95 (10.5) 310/2153 (14.4) 0.29 Hypercholesterolemia 23/95 (24.2) 624/2067 (30.2) 0.21 Hypertension 43/95 (45.3) 1080/2126 (50.8) 0.29 Myocardial infarction 12/95 (12.6) 285/2129 (13.4) 0.83 Previous stroke 8/95 (8.4) 322/2150 (15.0) 0.08 Current smoker, n (%) 26/70 (37.1) 470/1664 (28.2) 0.11 Use of antiplatelet, n (%) 26/95 (27.4) 638/2138 (29.8) 0.61 Use of anticoagulation, n (%) 8/95 (8.4) 371/2151 (17.2) 0.03 Initial location occlusion on CTA, n (%) Left hemisphere 57/95 (60.0) 1117/2168 (51.5) 0.11 Intracranial ICA 30/95 (31.6) 590/2164 (27.3) 0.19 M1 46/95 (48.4) 1287/2164 (59.5) M2 19/95 (20.0) 281/2164 (13.0) A1 0/95 (0) 3/2164 (0.1) A2 0/95 (0) 3/2164 (0.1) Collateral status, n (%) Absent collaterals 6/91 (6.6) 136/2050 (6.6) 0.68 <50% of occluded area 32/91 (35.2) 752/2050 (36.7) 50%–99% of occluded area 32/91 (35.2) 791/2050 (38.6) 100% of occluded area 21/91 (23.1) 371/2050 (18.1) NIHSS score, median (IQR) 15 (9–19) 16 (11–19) 0.24 Intravenous thrombolysis, n (%) 77/95 (81.1) 1673/2163 (77.3) 0.40 Pre-intervention SBP, mean (SD), mm Hg 152 (27) 149 (25) 0.26 A1, anterior cerebral artery, first segment; A2, anterior cerebral artery, second segment; CTA, computed tomography angiography; IA, intra-arterial; ICA, internal carotid artery; M1, middle cerebral artery, first segment; M2, middle cerebral artery, second segment; n, number; NIHSS, National Institutes of Health Stroke Scale; SBP, systolic blood pressure.
- Table 2
Procedural variables
Characteristics IA thrombolytics (n=95) No IA thrombolytics (n=2168) P value Thrombectomy technique, n (%)* Stent retriever 61/95 (64.2) 1647/2168 (76.0) 0.01 Aspiration 21/95 (22.1) 884/2168 (40.8) <0.001 Other 9/95 (9.5) 141/2168 (6.5) 0.26 Total revascularisation attempts, n (%) 1 19/67 (28.4) 803/1994 (40.3) 0.09 2 24/67 (35.8) 470/1994 (23.6) 3 10/67 (14.9) 316/1994 (15.8) ≥4 14/67 (20.9) 405/1994 (20.3) IA thrombolytics, n (%) Urokinase† 63/95 (66.3) N/A Alteplase‡ 32/95 (33.7) N/A IA thrombolytics attempt, n (%) Primary attempt 26/91 (28.6) N/A Adjuvant attempt 65/91 (71.4) N/A Location occlusion IA thrombolytics, n (%) Proximal occlusion 67/88 (76.1) N/A Distal occlusion 21/88 (23.9) N/A General anaesthesia, n (%) 32/90 (35.6) 562/2091 (26.9) 0.07 Time from stroke onset to groin puncture, median (IQR), minutes 200 (154–250) 190 (150–245) 0.37 Time from groin puncture to recanalisation or last contrast bolus, median (IQR), minutes 72 (58–108) 60 (40–85) <0.001 *Sum may be less than 100% due to administration of IA thrombolytics only, or exceed 100% due to a combination of treatment techniques.
†Median dose was 250 000 IU (IQR, 1 93 750–2 50 000).
‡Median dose was 20 mg (IQR, 12–20).
IA, intra-arterial; n, number; N/A, not applicable.
- Table 3
Secondary outcome variables
Characteristics IA thrombolytics (n=95) No IA thrombolytics (n=2168) OR 95% CI aOR* 95% CI Favourable functional outcome, n (%)† 43/88 (48.9) 897/2018 (44.4) 1.18 0.78 to 1.80 1.16 0.71 to 1.90 Successful reperfusion, n (%)‡ 45/92 (48.9) 1429/2120 (67.4) 0.46 0.30 to 0.70 0.57 0.36 to 0.90 Excellent reperfusion, n (%)§ 29/92 (31.5) 992/2120 (46.8) 0.54 0.35 to 0.85 0.68 0.43 to 1.09 Early neurological recovery, n (%)¶ 6/91 (6.6) 153/1962 (7.8) 0.83 0.36 to 1.93 0.96 0.40 to 2.29 Symptomatic intracranial haemorrhage, n (%)** 5/95 (5.3) 129/2168 (6.0) 0.88 0.35 to 2.20 0.82 0.32 to 2.10 *Results were adjusted for age, a medical history of atrial fibrillation and previous stroke, use of anticoagulation, National Institutes of Health Stroke Scale score at baseline, collateral score, intravenous thrombolysis, procedural use of heparin and time from groin puncture to recanalisation or last contrast bolus.
†Favourable functional outcome was defined as an modified Rankin Scale score of ≤2 at 90 days after EVT.
‡Successful reperfusion was defined as extended Thrombolysis In Cerebral Infarction score of ≥2B.
§Excellent reperfusion was defined as extended Thrombolysis In Cerebral Infarction score of ≥2C.
¶Early neurological recovery was defined as National Institutes of Health Stroke Scale score of 0 or 1 within 24 hours postprocedural, or a decrease of 8 points relative to baseline.
**An intracranial haemorrhage was considered to be symptomatic if patients deteriorated neurologically (a decline of at least four points on the National Institutes of Health Stroke Scale) or died within 90 days after endovascular thrombectomy and the haemorrhage was related to the clinical deterioration (according to the Heidelberg criteria).
aOR, adjusted OR; IA, intra-arterial; n, number.
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