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Effect of baseline infarct size on endovascular thrombectomy with or without intravenous alteplase in stroke patients

European Journal of Neurology Feb 15, 2022

In patients with acute ischaemic stroke, baseline infarct size may not alter the impact of alteplase prior to endovascular thrombectomy regarding favorable functional outcomes and adverse events.

  • In the DIRECT-MT, endovascular thrombectomy was shown to be non-inferior to thrombectomy preceded by intravenous alteplase regarding functional outcome in patients with acute ischaemic stroke.

  • This post-hoc analysis was conducted to determine if infarct size altered the impact of alteplase.

  • All patients with baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS) grade were included; Of 649 cases, 323 (49.8%) were in the thrombectomy-alone group and 326 (50.2%) in the combination-therapy group.

  • For the primary endpoint of ordinal modified Rankin Scale (mRS), there was no significant treatment-by-trichotomized ASPECTS interaction with alteplase prior to endovascular treatment (p-value interaction term compared to ASPECTS 8-10: ASPECTS 0-4, p=0.386; ASPECTS 5-7, p=0.936).

  • Adjusted common odds ratio for improvement in the 90-day mRS with thrombectomy alone vs combination therapy was estimated to be 1.99 for ASPECTS 0-4, 1.07 for ASPECTS 5-7, and 1.03 for ASPECTS 8-10.

  • The two groups did not differ significantly in terms of safety outcomes.


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