Por favor, use este identificador para citar o enlazar a este item:
http://hdl.handle.net/10261/341426
COMPARTIR / EXPORTAR:
SHARE CORE BASE | |
Visualizar otros formatos: MARC | Dublin Core | RDF | ORE | MODS | METS | DIDL | DATACITE | |
Título: | Adjunct Thrombolysis Enhances Brain Reperfusion following Successful Thrombectomy |
Autor: | Laredo, Carlos; Rodríguez, Alejandro CSIC ORCID; Oleaga, Laura; Hernández-Pérez, María; Renú, Arturo; Puig, Josep; San Román, Luis; Planas, Anna M. CSIC ORCID; Urra, Xabier CSIC ORCID; Chamorro, Ángel | Fecha de publicación: | nov-2022 | Editor: | John Wiley & Sons | Citación: | Annals of Neurology 92(5): 860-870 (2022) | Resumen: | Objective: This study was undertaken to investigate whether adjunct alteplase improves brain reperfusion following successful thrombectomy. Methods: This single-center, randomized, double-blind, placebo-controlled study included 36 patients (mean [standard deviation] = 70.8 [13.5] years old, 18 [50%] women) with large vessel occlusion undergoing thrombectomy resulting in near-normal (expanded Thrombolysis in Cerebral Infarction [eTICI] b50/67/2c, n = 23, 64%) or normal angiographic reperfusion (eTICI 3, n = 13, 36%). Seventeen patients were randomized to intra-arterial alteplase (0.225mg/kg), and 19 received placebo. At 48 hours, patients had brain perfusion/diffusion-weighted magnetic resonance imaging (MRI) and MRI-spectroscopy. The primary outcome was the difference in the proportion of patients with areas of hypoperfusion on MRI. Secondary outcomes were the infarct expansion ratio (final to initial infarction volume), and the N-acetylaspartate (NAA) peak relative to total creatine as a marker of neuronal integrity. Results: The prevalence of hypoperfusion was 24% with intra-arterial alteplase, and 58% with placebo (adjusted odds ratio = 0.20, 95% confidence interval [CI] = 0.04–0.91, p = 0.03). Among 14 patients with final eTICI 3 scores, hypoperfusion was found in 1 of 7 (14%) in the alteplase group and 3 of 7 (43%) in the placebo group. Abnormal brain perfusion was associated with worse functional outcome at day 90. Alteplase significantly reduced the infarct expansion ratio compared with placebo (median [interquartile range (IQR)] = 0.7 [0.5–1.2] vs 3.2 [1.8–5.7], p = 0.01) and resulted in higher NAA peaks (median [IQR] = 1.13 [0.91–1.36] vs 1.00 [0.74–1.22], p < 0.0001). Interpretation: There is a high prevalence of areas of hypoperfusion following thrombectomy despite successful reperfusion on angiography. Adjunct alteplase enhances brain reperfusion, which results in reduced expansion of the infarction and improved neuronal integrity. ANN NEUROL 2022;92:860–870. | Versión del editor: | http://dx.doi.org/10.1002/ana.26474 | URI: | http://hdl.handle.net/10261/341426 | DOI: | 10.1002/ana.26474 | Identificadores: | doi: 10.1002/ana.26474 issn: 1531-8249 |
Aparece en las colecciones: | (IIBB) Artículos |
Ficheros en este ítem:
Fichero | Descripción | Tamaño | Formato | |
---|---|---|---|---|
Annals of Neurology - 2022 - Laredo - Adjunct Thrombolysis Enhances Brain Reperfusion following Successful Thrombectomy.pdf | 3,31 MB | Adobe PDF | Visualizar/Abrir |
CORE Recommender
SCOPUSTM
Citations
15
checked on 25-abr-2024
WEB OF SCIENCETM
Citations
13
checked on 28-feb-2024
Page view(s)
20
checked on 30-abr-2024
Download(s)
10
checked on 30-abr-2024
Google ScholarTM
Check
Altmetric
Altmetric
Este item está licenciado bajo una Licencia Creative Commons