Mujanović, AdnanAdnanMujanovićDobrocky, TomasTomasDobrockyPfeilschifter, WaltraudWaltraudPfeilschifterRemonda, LucaLucaRemondaCaroff, JildazJildazCaroffBehme, DanielDanielBehmeSeiffge, David JulianDavid JulianSeiffgeCereda, Carlo WCarlo WCeredaKägi, GeorgGeorgKägiLeyon, JoeJoeLeyonPiechowiak, Eike ImmoEike ImmoPiechowiakCostalat, VincentVincentCostalatWagner, JudithJudithWagnerChabert, EmmanuelEmmanuelChabertMeinel, Thomas RaphaelThomas RaphaelMeinel0000-0002-0647-9273Jansen, OlavOlavJansenAlonso, AngelikaAngelikaAlonsoLoehr, ChristianChristianLoehrLiebeskind, David SDavid SLiebeskindGralla, JanJanGrallaFischer, Urs MartinUrs MartinFischerKaesmacher, JohannesJohannesKaesmacher2024-10-262024-10-262024-06https://boris-portal.unibe.ch/handle/20.500.12422/174936BACKGROUND AND PURPOSE The value of intravenous thrombolysis (IVT) in eligible tandem lesion patients undergoing endovascular treatment (EVT) is unknown. We investigated treatment effect heterogeneity of EVT + IVT versus EVT-only in tandem lesion patients. Additional analyses were performed for patients undergoing emergent internal carotid artery (ICA) stenting. METHODS SWIFT DIRECT randomized IVT-eligible patients to either EVT + IVT or EVT-only. Primary outcome was 90-day functional independence (modified Rankin Scale score 0-2) after the index event. Secondary endpoints were reperfusion success, 24 h intracranial hemorrhage rate, and 90-day all-cause mortality. Interaction models were fitted for all predefined outcomes. RESULTS Among 408 included patients, 63 (15.4%) had a tandem lesion and 33 (52.4%) received IVT. In patients with tandem lesions, 20 had undergone emergent ICA stenting (EVT + IVT: 9/33, 27.3%; EVT: 11/30, 36.7%). Tandem lesion did not show treatment effect modification of IVT on rates of functional independence (tandem lesion EVT + IVT vs. EVT: 63.6% vs. 46.7%, non-tandem lesion EVT + IVT vs. EVT: 65.6% vs. 58.2%; p for interaction = 0.77). IVT also did not increase the risk of intracranial hemorrhage  among tandem lesion patients (tandem lesion EVT + IVT vs. EVT: 34.4% vs. 46.7%, non-tandem lesion EVT + IVT vs. EVT: 33.5% vs. 26.3%; p for interaction = 0.15). No heterogeneity was noted for other endpoints (p for interaction > 0.05). CONCLUSIONS No treatment effect heterogeneity of EVT + IVT versus EVT-only was observed among tandem lesion patients. Administering IVT in patients with anticipated emergent ICA stenting seems safe, and the latter should not be a factor to consider when deciding to administer IVT before EVT.enextracranial stent intravenous thrombolysis mechanical thrombectomy randomized controlled trial tandem lesion600 - Technology::610 - Medicine & healtharticle10.48350/1934913840987410.1111/ene.16256