Ultra-early rt-PA administration should improve patient outcome on mechanical thrombectomy: Post hoc analysis of SKIP.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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Aoki Junya, Suzuki Kentaro, Sakamoto Yuki, Matsumaru Yuji, Takeuchi Masataka, Morimoto Masafumi, Kanazawa Ryuzaburo, Takayama Yohei, Kamiya Yuki, Shigeta Keigo, Okubo Seiji, Hayakawa Mikito, Ishii Norihiro, Koguchi Yorio, Takigawa Tomoji, Inoue Masato, Naito Hiromichi, Ota Takahiro, Hirano Teruyuki, Kato Noriyuki, Ueda Toshihiro, Iguchi Yasuyuki, Akaji Kazunori, Tsuruta Wataro, Miki Kazunori, Fujimoto Shigeru, Higashida Tetsuhiro, Iwasaki Mitsuhiro, Kanamaru Takuya, Saito Tomonari, Katano Takehiro, Kutsuna Akihito, Nishiyama Yasuhiro, Otsuka Toshiaki, Kimura Kazumi, SKIP study Investigators
Аннотация
METHODS: Participants comprised rt-PA-eligible 204 patients with internal carotid artery or middle cerebral artery occlusion in the SKIP trial, who were randomly assigned to receive mechanical thrombectomy alone or combined intravenous thrombolysis (rt-PA: alteplase at 0.6 mg/kg) plus mechanical thrombectomy. We assessed associations between onset-to-puncture time and onset-to-rt-PA administration time and frequency of favorable outcome at 90 days and any intracerebral hemorrhage (ICH) at 36 h after onset.
RESULTS: As a cut-off onset-to-puncture time for favorable outcome, receiver operating characteristic curves defined 2.5 h (57% sensitivity, 62% specificity). For onset-to-puncture times ≤2.5 h and > 2.5 h, frequencies of favorable outcomes were 72% and 63% (p = 0.402) in patients with rt-PA therapy and 44% and 58% (p = 0.212) in patients without rt-PA therapy, respectively. In terms of onset-to-rt-PA administration time, frequencies of favorable outcomes among patients with ultra-early rt-PA administration at ≤100, >100 min after onset, and without rt-PA therapy with onset-to-puncture time ≤ 2.5 h, and with and without rt-PA therapy with onset-to-puncture time > 2.5 h were 84% and 64%, 63%, and 44% and 58%, respectively (p = 0.025). Frequencies of any ICH among those patients were 37% and 32%, 32%, and 63% and 40%, respectively (p = 0.006).
CONCLUSION: Ultra-early rt-PA administration should improve patient outcomes on mechanical thrombectomy among patients with LVO. Relatively late rt-PA administration might increase the frequency of any ICH.