RT Journal Article
SR Electronic
T1 Clinical imaging factors of excellent outcome after thrombolysis in large-vessel stroke: a THRACE subgroup analysis
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 631
OP 639
DO 10.1136/svn-2020-000852
VO 6
IS 4
A1 Riou-Comte, Nolwenn
A1 Gory, Benjamin
A1 Soudant, Marc
A1 Zhu, François
A1 Xie, Yu
A1 Humbertjean, Lisa
A1 Mione, Gioia
A1 Oppenheim, Catherine
A1 Guillemin, Francis
A1 Bracard, Serge
A1 Richard, Sébastien
A1 
YR 2021
UL http://svn.bmj.com/content/6/4/631.abstract
AB Background For patients with stroke with large-vessel occlusion (LVO), study of factors predicting response to intravenous thrombolysis (IVT) would allow identifying subgroups with high expected gain, and those for whom it could be considered as futile, and even detrimental. From patients included in the Mechanical Thrombectomy After Intravenous Alteplase vs Alteplase Alone After Stroke trial, we investigated clinical-imaging factors associated with optimal response to IVT.Methods We included patients receiving IVT alone. Excellent outcome was defined by a 3-month modified Rankin Scale (mRS) score ≤1. Clinical-imaging predictors were assessed on multivariate analysis after multiple imputations. The predictive performance of the model was assessed with the C-statistic.Results Among 247 patients with LVO treated with IVT alone, 77 (31%) showed 3-month mRS ≤1. Predictors of 3-month mRS ≤1 were no medical history of hypertension (OR 2.43; 95% CI 1.74 to 3.38; p=0.007); no current smoking (OR 2.76; 95% CI 1.79 to 4.26; p=0.02); onset-to-IVT time (OR 0.47 per hour increase; 95% CI 0.23 to 0.78; p=0.003); diffusion-weighted imaging (DWI) volume (OR 0.78 per 10 mL increase; 95% CI 0.68 to 0.89; p=0.0004); presence of susceptibility vessel sign (SVS) (OR 7.89; 95% CI 1.65 to 37.78; p=0.01) and SVS length (OR 0.87 per mm increase; 95% CI 0.80 to 0.94; p=0.001). The prediction models showed a C-statistic=0.79 (95% CI 0.79 to 0.80).Conclusions In patients with stroke with anterior-circulation LVO treated with IVT alone, predictors of excellent outcome at 3 months were no medical history of hypertension or current smoking, reduced onset-to-IVT time, small DWI volume, presence of SVS and short SVS length. These predictive factors could help practitioners in decision-making for IVT implementation in reperfusion strategies, all the more for the drip and ship paradigm.Trial registration number NCT01062698.Data are available on reasonable request. Only data that are relevant for the main objective of this ancillary study were available from the THRACE trial in agreement with the principal investigator of the trial. Individual de-identified participant data were shared following the explanation of the main objective and the statistical analysis. Data are available on reasonable request to SR (s.richard@chru-nancy.fr).