دورية أكاديمية
Does stereotactic thrombolysis with alteplase for intracerebral haemorrhage alter intraventricular haematoma volume? A secondary analysis of the MISTIE-III trial
| العنوان: | Does stereotactic thrombolysis with alteplase for intracerebral haemorrhage alter intraventricular haematoma volume? A secondary analysis of the MISTIE-III trial |
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| المؤلفون: | Sun, Philip, Badihian, Shervin, Avadhani, Radhika, Walborn, Nathan, Yarava, Anusha, Alimoradi, Donya, Awad, Issam, Hanley, Daniel, Murthy, Santosh, Ziai, Wendy |
| المساهمون: | National Institute of Neurological Disorders and Stroke |
| المصدر: | Journal of Neurology, Neurosurgery & Psychiatry ; page jnnp-2023-333032 ; ISSN 0022-3050 1468-330X |
| بيانات النشر: | BMJ |
| سنة النشر: | 2024 |
| الوصف: | Background Stereotactic thrombolysis reduces intracerebral haemorrhage (ICH) volume in patients with spontaneous ICH. Whether intrahaematomal alteplase administration is associated with a change in intraventricular haemorrhage volume (deltaIVH) and functional outcomes is unknown. Methods Post hoc secondary analysis of the Minimally Invasive Surgery plus Alteplase for Intracerebral Hemorrhage Evacuation Phase III (MISTIE-III) trial in patients with IVH on the stability CT scan. Exposure was minimally invasive surgery plus alteplase (MIS+alteplase). Primary outcome was deltaIVH defined as IVH volume on end-of-treatment CT minus IVH volume on stability CT scan. Secondary outcomes were favourable functional outcome (modified Rankin Scale 0–3) and mortality at 365 days. We assessed the relationship between MIS+alteplase and deltaIVH in the primary analysis using multivariable linear regression, and between deltaIVH and functional outcomes in secondary analyses using multiple logistic regression. Results Of 499 patients in MISTIE-III, 310 (62.1%) had IVH on stability scans; mean age (SD) was 61.2±12.3 years. A total of 146 (47.1%) received the MISTIE procedure and 164 (52.9%) standard medical care (SMC) only. The MIS+alteplase group had a greater mean reduction in IVH volume compared with the SMC group (deltaIVH: −2.35 (5.30) mL vs −1.15 (2.96) mL, p=0.02). While IVH volume decreased significantly in both treatment groups, in the primary analysis, MIS+alteplase was associated with greater deltaIVH in multivariable linear regression analysis adjusted for potential confounders (β −0.80; 95% CI −1.37 to −0.22, p=0.007). Secondary analysis demonstrated no associations between IVH reduction and functional outcomes (adjusted OR (aOR) for poor outcome 1.02; 95% CI 0.96 to 1.08, p=0.61; aOR for mortality 0.99; 95% CI 0.92 to 1.06, p=0.77). Conclusions Alteplase delivered into the ICH in MISTIE-III subjects with IVH was associated with a small reduction in IVH volume. This reduction did not translate into a significant benefit ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| ردمك: | 978-2-02-333303-7 2-02-333303-2 |
| DOI: | 10.1136/jnnp-2023-333032 |
| الإتاحة: | https://doi.org/10.1136/jnnp-2023-333032Test |
| رقم الانضمام: | edsbas.BCDB75CD |
| قاعدة البيانات: | BASE |
| ردمك: | 9782023333037 2023333032 |
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| DOI: | 10.1136/jnnp-2023-333032 |