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  • Effect of intravenous thrombolysis before endovascular therapy on outcome according to collateral status: insight from the ETIS Registry

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Ischemic stroke
Original research
Effect of intravenous thrombolysis before endovascular therapy on outcome according to collateral status: insight from the ETIS Registry
  1. Mohammad Anadani1,
  2. Anne-Christine Januel2,
  3. Stephanos Finitsis3,
  4. Frédéric Clarençon4,
  5. Sébastien Richard5,
  6. Gaultier Marnat6,
  7. Romain Bourcier7,
  8. Igor Sibon8,
  9. Cyril Dargazanli9,
  10. Caroline Arquizan10,
  11. Raphael Blanc11,
  12. Bertrand Lapergue12,
  13. Arturo Consoli13,
  14. Francois Eugene14,
  15. Stephane Vannier15,
  16. Jildaz Caroff16,
  17. Christian Denier17,
  18. Marion Boulanger18,
  19. Maxime Gauberti19,
  20. Aymeric Rouchaud20,21,
  21. Francisco Macian Montoro21,
  22. Charlotte Rosso22,
  23. Wagih Ben Hassen23,24,
  24. Guillaume Turc19,
  25. Ozlem Ozkul-Wermester25,
  26. Chrysanthi Papagiannaki26,
  27. Jean François Albucher27,
  28. Anthony Le Bras28,29,
  29. Sarah Evain30,
  30. Valerie Wolff31,
  31. Raoul Pop32,33,
  32. Serge Timsit34,
  33. Jean-Christophe Gentric35,
  34. Frederic Bourdain36,
  35. Louis Veunac37,
  36. Adam de Havenon38,
  37. David S Liebeskind39,
  38. Benjamin Maier40,
  39. Benjamin Gory41
  40. On behalf of the ETIS Registry Investigators
    1. 1 Neurosurgery, Medical University of South Carolina - College of Medicine, Charleston, South Carolina, USA
    2. 2 Neuroradiology, University Hospital of Purpan, Toulouse, France
    3. 3 Neuroradiolology, University General Hospital of Thessaloniki AHEPA, Thessaoniki, Greece
    4. 4 Interventional Neuroradiology, University Hospital Pitié Salpêtrière, Paris, France
    5. 5 Neurology Stroke Unit, University Hospital Centre Nancy, Nancy, France
    6. 6 Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
    7. 7 CHU de Nantes, Nantes, France
    8. 8 CHU de Bordeaux, Bordeaux, France
    9. 9 Department of Neuroradiology, University Hospital Centre Montpellier, Montpellier, France
    10. 10 Neurology, CHRU Gui de Chauliac, Montpellier, France
    11. 11 Interventional Neuroradiology, Fondation Rothschild, Paris, France
    12. 12 Neurology, Stroke Unit, Hospital Foch, Suresnes, France
    13. 13 Hopital Foch, Suresnes, France
    14. 14 Radiologie, CHU Rennes, Rennes, France
    15. 15 Department of Neurology, CHU Rennes, Rennes, France
    16. 16 Department of Interventional Neuroradiology - NEURI Brain Vascular Center, Bicêtre Hospital, APHP, Le Kremlin Bicêtre, France
    17. 17 Neurology, Hôpital Bicetre, Le Kremlin-Bicetre, Île-de-France, France
    18. 18 Neurology, CHU Caen, Caen, France
    19. 19 Centre Hospitalier Universitaire de Limoges, Limoges, Limousin, France
    20. 20 Interventional Neuroradiology, Centre Hospitalier Universitaire de Limoges, Limoges, France
    21. 21 Department of Neurology, CHU Limoges, Limoges, France
    22. 22 Urgences Cérébro-Vasculaires, Pitié-Salpétrière Hospital, Paris, France
    23. 23 Interventional Neuroradiology, Saint Anne Hospital Centre, Paris, France
    24. 24 INSERM U1166, Paris, France
    25. 25 Department of Neurology, CHU Rouen, Rouen, France
    26. 26 Interventional Neuroradiology, CHU Rouen, Rouen, France
    27. 27 Neurology, University Hospital Centre Toulouse, Toulouse, France
    28. 28 Department of Radiology, CH Bretagne Atlantique, Vannes, France
    29. 29 CHU Rennes Service de Radiologie et d'Imagerie Médicale, Rennes, France
    30. 30 Department of Neurology, Centre Hospitalier Bretagne Atlantique, Vannes, France
    31. 31 Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
    32. 32 Interventional Neuroradiology, University Hospitals Strasbourg, Strasbourg, France
    33. 33 Interventional Radiology, Institut de Chirurgie Guidée par l'Image, Strasbourg, France
    34. 34 Department of Neurology, CHU Brest, Brest, France
    35. 35 Neuroradiology, CHRU de Brest, Brest, France
    36. 36 Neurology, Centre Hospitalier de la Cote Basque, Bayonne, Aquitaine, France
    37. 37 Department of Radiology and Interventional Neuroradiology, CHU de Bordeaux, Bordeaux, France
    38. 38 Department of Neurology, University of Utah, Salt Lake City, Utah, USA
    39. 39 Neurology, UCLA, Los Angeles, California, USA
    40. 40 Interventional Neuroradiology, Adolphe de Rothschild Ophthalmological Foundation, Paris, France
    41. 41 Department of Diagnostic and Interventional Neuroradiology, CHRU Nancy, Nancy, France
    1. Correspondence to Dr Mohammad Anadani, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA; anadani{at}musc.edu

    Abstract

    Background It is unknown whether collateral status modifies the effect of pretreatment intravenous thrombolysis (IVT) on the outcomes of patients with large vessel occlusions treated with endovascular therapy (EVT). We aimed to assess whether collateral status modifies the effect of IVT on the outcomes of EVT in clinical practice.

    Methods We used data from the ongoing prospective multicentric Endovascular Treatment in Ischemic Stroke (ETIS) Registry in France. Patients with anterior circulation proximal large vessel occlusions treated with EVT within 6 hours of symptom onset were enrolled. Patients were divided into two groups based on pretreatment with IVT. The two groups were matched based on baseline characteristics. We tested the interaction between collateral status and IVT in unadjusted and adjusted models.

    Results A total of 1589 patients were enrolled in the study, of whom 55% received IVT. Using a propensity score matching method, 724 no IVT patients were matched to 549 IVT patients. In propensity score weighted analysis, IVT was associated with higher odds of early neurological improvement (OR 1.74; 95% CI 1.33 to 2.26), favorable functional outcome (OR 1.66; 95% CI 1.23 to 2.24), excellent functional outcome (OR 2.04; 95% CI 1.47 to 2.83), and successful reperfusion (OR 2.18; 95% CI 1.51 to 3.16). IVT was not associated with mortality or hemorrhagic complications. There was no interaction between collateral status and IVT association with any of the outcomes.

    Conclusions Collateral status does not modify the effect of pretreatment IVT on the efficacy and safety outcomes of EVT.

    • thrombolysis
    • thrombectomy
    • stroke

    Data availability statement

    Data are available upon reasonable request.

    https://doi.org/10.1136/neurintsurg-2021-018170

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      Data availability statement

      Data are available upon reasonable request.

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      Footnotes

      • Twitter @jildazz, @RaoulPop25, @BenjaminMaierMD

      • Collaborators List of Endovascular Treatment in Ischemic Stroke (ETIS) Investigators:Michel Piotin, Raphael Blanc, Hocine Redjem, Simon Escalard, Jean-Philippe Dessilles, François Delvoye, Stanislas Smajda, Benjamin Maier, Hebert Solène, Mikael Mazighi, Mikael Obadia, Candice Sabben, Pierre Seners, Igor Raynouard, Ovide Corabianu, Thomas de Broucker, Eric Manchon, Guillaume Taylor, Malek Ben Maacha, Laurie-Anne Thion, Augustin Lecler, Julien Savatovsky, Pierre Seners.Adrien Wang, Serge Evrard, Maya Tchikviladze, Nadia Ajili, Bertrand Lapergue, David Weisenburger-Lile, Lucas Gorza, Géraldine Buard, Oguzhan Coskun, Arturo Consoli, Federico Di Maria, Georges Rodesh, Sergio Zimatore, Morgan Leguen, Julie Gratieux, Fernando Pico, Haja Rakotoharinandrasana, Philippe Tassan, Roxanna Poll, Sylvie Marinier,Gaultier Marnat, Florent Gariel, Xavier Barreau, Jérôme Berge, Patrice Menegon, Igor Sibon, Ludovic Lucas, Stéphane Olindo, Pauline Renou, Sharmila Sagnier, Mathilde Poli, Sabrina Debruxelles, François Rouanet, Thomas Tourdias, Jean-Sebastien Liegey, Pierre Briau, Nicolas Pangon.Romain Bourcier, Lili Detraz, Benjamin Daumas-Duport, Pierre-Louis Alexandre, Monica Roy, Cédric Lenoble, Hubert Desal, Benoît Guillon, Solène de Gaalon, Cécile Preterre, Benjamin Gory, Serge Bracard, René Anxionnat, Marc Braun, Anne-Laure Derelle, Romain, Tonnelet, Liang Liao, François Zhu, Emmanuelle Schmitt, Sophie Planel, Sébastien Richard, Lisa Humbertjean, Gioia Mione, Jean-Christophe Lacour, Gérard Audibert, Marcela Voicu, Lionel Alb, Marie Reitter, Madalina Brezeanu, Agnès Masson, Adriana Tabarna, Iona Podar, Sarah Guy, Fatiha Bechiri, Pauline Bourst, Francisco Macian-Montoro, Suzanna Saleme, Charbel Mounayer, Aymeric Rouchaud, Laetitia Gimenez, Alexandre Cosnard., Vincent Costalat, Caroline Arquizan, Cyril Dargazanli, Grégory Gascou, Pierre-Henri Lefèvre, Imad Derraz, Carlos Riquelme, Nicolas Gaillard, Isabelle Mourand, Lucas Corti, Federico Cagnazzo, Adrien ter Schiphorst.Francois Eugene, Stéphane Vannier, Jean-Christophe Ferre, Hélène Raoult, Thomas Ronziere, Maria Lassale, Christophe Paya, Jean-Yves Gauvrit, Clément Tracol, Sophie Langnier-Lemercier, Axelle Maurice, Sabrina Cochennec, Mélanie Pinault.Frédéric Clarençon, Charlotte Rosso, Eimad Shotar, Nader Sourour, Stéphanie Lenck, Kévin Premat, Yves Samson, Anne Léger, Sophie Crozier, Flore Baronnet, Sonia Alamowitch, Laure Bottin, Mathon Yger, Vincent Degos., Laurent Spelle, Christian Denier, Olivier Chassin, Vanessa Chalumeau, Jildaz Caroff, Olivier Chassin, Laura Venditti, Mariana Sarov, Nicolas Legris., Olivier Naggara, Wagih Ben Hassen, Grégoire Boulouis, Christine Rodriguez-Régent, Denis Trystram, Basile Kerleroux, Wassim Farhat, Olivier Heinzlef, Guillaume Turc, Valérie Domigo, Catherine Lamy, Julia Birchenall, Clothilde Isabel, François Lun., Alain Viguier, Christophe Cognard, Anne Christine Januel, Jean-Marc Olivot, Louis Fontaine, Nicolas Raposo, Fabrice Bonneville, Jean François Albucher, Lionel Calviere, Jean Darcourt, Guillaume Bellanger, Philippe Tall., Emmanuel Touze, Charlotte Barbier, Romain Schneckenburger, Marion Boulanger, Julien Cogez, Sophie Guettier, Maxime Gauberti., Serge Timsit, Jean-Christophe Gentric, Julien Ognard, Francois Mathias Merrien.Ozlem Ozkul-Wermester, Evelyne Guegan-Massardier, Chrysanthi Papagiannaki, Aude Triquenot, Margaux Lefebvre.Frédéric Bourdain, Patricia Bernady, Laurent Lagoarde-Segot, Hélène Cailliez, Louis Veunac, David Higue.Valérie Wolff, Veronique Quenardelle, Valerie Lauer, Roxana Gheoca, Irene Pierre-Paul, Raoul Pop, Remy Beaujeux, Dan Mihoc, Monica Manisor, Julien Pottecher, Alain Meyer, Thiên-Nga Chamaraux-Tran., Anthony Le Bras, Sarah Evain, Arnaud Le Guen.

      • Contributors MA, SF, BG accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. Substantial contributions to the conception or design of the work: MA, SF, AdH, DSL, BG. Acquisition, analysis, and interpretation of the data for the work: FC,SR, GM, RB, IS, CD, CA, RB, BL, AC, FE, SV, LS, CD, MB, MG, SS, FM, CR, ON, GT, OO, CP, AV, CC, AlB, SE, VW, RP, ST, JG, FB, LV, BM. Drafting the work or revising it critically for important intellectual content: MA; SF, AdH, DSL, BG.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.