SGEM#349: Can tPA Be A Bridge Over Trouble Waters to Mechanical Thrombectomy?

Trials extracted from the podcast by Dr. Ken Milne

• 2021Utility of Intravenous Alteplase Prior to Endovascular Stroke TreatmentOtherIn 1,092 thrombolysis-eligible patients with large-vessel-occlusion stroke, direct thrombectomy matched alteplase bridging therapy for mRS 0-2 at 3 months.
• 2015MR CLEANOtherIn 500 patients with acute anterior circulation large-vessel occlusion, intraarterial treatment improved 90-day functional outcome versus usual care alone.
• 2020DIRECT-MTOtherIn 656 patients with anterior-circulation large-vessel occlusion, thrombectomy alone was non-inferior for 90-day disability to alteplase before thrombectomy.
• 2021DEVTOtherIn 234 patients with anterior-circulation large-vessel-occlusion stroke, thrombectomy alone was non-inferior to bridging alteplase plus thrombectomy for 90-day functional independence.
• 2021SKIPOtherIn 204 patients with large-vessel-occlusion stroke, thrombectomy alone failed to show noninferiority to bridging thrombolysis plus thrombectomy for 90-day mRS 0-2.
• 2016HERMESOtherIn 1287 patients with proximal anterior circulation ischaemic stroke, endovascular thrombectomy reduced 90-day disability compared with standard care.
• 2018INTERRSeCTOtherIn575 patients with acute ischemic stroke and intracranial arterial occlusion on CTA,intravenous alteplaseachievedearly recanalizationmore often thanno thrombolysis.
• 2018EXTEND-IA TNKCoronary & InterventionIn 202 patients with large-vessel-occlusion ischemic stroke, tenecteplase before thrombectomy improved pre-thrombectomy reperfusion compared with alteplase.
• 1999ASSENT-2OtherIn 16,949 patients with acute myocardial infarction of less than 6 hours' duration, single-bolus tenecteplase was equivalent to front-loaded alteplase for 30-day all-cause mortality.
• 2021MR CLEAN-NO IVOtherIn539 patients with acute ischemic stroke from large-vessel occlusion at thrombectomy-capable centres,direct endovascular treatmentwas neither superior nor non-inferior for90-day disabilityversusalteplase before thrombectomy.
• 2022SWIFT DIRECTOtherIn 423 patients with large-vessel occlusion stroke, thrombectomy alone missed non-inferiority for 90-day independence versus bridging alteplase plus thrombectomy
• 2006Time Is Brain—QuantifiedOtherIn typical large-vessel ischemic stroke, untreated ischemia destroys 1.9 million neurons per minute, ageing the brain 3.6 years per hour versus normal brain ageing.
• 2017Access to hyperacute stroke services across Canadian provinces: a geospatial analysisOtherIn the 2011 population of8 Canadian provinces, modelledground EMS transportrather thanprivate transportput84.7-99.8% within 5 hours of an EVT site.