Comparison of intravenous alteplase with a combined intravenous–endovascular approach in patients with stroke and confirmed arterial occlusion (RECANALISE study): a prospective cohort study - 07/08/11
on behalf of the REcanalisation using Combined intravenous Alteplase and Neurointerventional ALgorithm for acute Ischemic StrokE (RECANALISE) investigators
Summary |
Background |
The efficacy of intravenous (IV) alteplase is restricted by the speed of recanalisation and the site of the occlusion. The aim of this study was to ascertain the effect of a combined IV–endovascular approach (intra-arterial alteplase and, if required, additional thrombectomy) in patients with stroke due to arterial occlusion.
Methods |
We compared recanalisation rates, neurological improvement at 24 h, and functional outcome at 3 months between two periods (February, 2002, to March, 2007, vs April, 2007, to October, 2008) in patients in a prospective registry who were treated with different regimens of alteplase within 3 h of symptom onset. Patients with confirmed occlusion who were treated before April, 2007, were treated with IV alteplase; after April, 2007, patients were treated with a systematic IV–endovascular approach. Analysis was by intention to treat.
Findings |
46 (87%) of 53 patients treated with the IV–endovascular approach achieved recanalisation versus 56 (52%) of 107 patients in the IV group (adjusted relative risk [RR] 1·49, 95% CI 1·21–1·84; p=0·0002). Early neurological improvement (NIHSS score of 0 or 1 or an improvement of 4 points or more at 24 h) occurred in 32 (60%) patients in the IV–endovascular group and 42 (39%) patients in the IV group (adjusted RR 1·36, 0·97–1·91; p=0·07). Favourable outcome (mRS of 0–2 at 90 days) occurred in 30 (57%) patients in the IV–endovascular group and 47 (44%) patients in the IV group (adjusted RR 1·16, 0·85–1·58; p=0·35). The mortality rate at 90 days was 17% in both groups, and symptomatic intracranial haemorrhage was reported in five (9%) patients in the IV–endovascular group and in 12 (11%) patients in the IV group. Better clinical outcome was associated with recanalisation in both groups and with time to recanalisation in the IV–endovascular group.
Interpretation |
An IV–endovascular approach is associated with higher recanalisation rates than is IV alteplase in patients with stroke and confirmed arterial occlusion. In patients treated with an IV–endovascular approach, a shorter time from symptom onset to recanalisation is associated with better clinical outcomes.
Funding |
SOS-ATTAQUE CEREBRALE.
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Vol 8 - N° 9
P. 802-809 - septembre 2009 Retour au numéro
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