Mujanovic, AdnanAdnanMujanovicEker, OmerOmerEkerMarnat, GaultierGaultierMarnatStrbian, DanielDanielStrbianIjäs, PetraPetraIjäsPréterre, CécileCécilePréterreTriquenot, AudeAudeTriquenotAlbucher, Jean FrançoisJean FrançoisAlbucherGauberti, MaximeMaximeGaubertiWeisenburger-Lile, DavidDavidWeisenburger-LileErnst, MarielleMarielleErnstNikoubashman, OmidOmidNikoubashmanMpotsaris, AnastasiosAnastasiosMpotsarisGory, BenjaminBenjaminGoryTuan Hua, ViViTuan HuaRibo, MarcMarcRiboLiebeskind, David SDavid SLiebeskindDobrocky, TomasTomasDobrockyMeinel, Thomas RaphaelThomas RaphaelMeinel0000-0002-0647-9273Bütikofer, LukasLukasBütikoferGralla, JanJanGrallaFischer, Urs MartinUrs MartinFischerKaesmacher, JohannesJohannesKaesmacher2024-10-112024-10-112023-11https://boris-portal.unibe.ch/handle/20.500.12422/89016BACKGROUND A potential benefit of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT) is pre-interventional reperfusion. Currently, there are few data on the occurrence of pre-interventional reperfusion in patients randomized to IVT or no IVT before MT. METHODS SWIFT DIRECT (Solitaire With the Intention For Thrombectomy Plus Intravenous t-PA vs DIRECT Solitaire Stent-retriever Thrombectomy in Acute Anterior Circulation Stroke) was a randomized controlled trial including acute ischemic stroke IVT eligible patients being directly admitted to a comprehensive stroke center, with allocation to IVT with MT versus MT alone. The primary endpoint of this analysis was the occurrence of pre-interventional reperfusion, defined as a pre-interventional expanded Thrombolysis in Cerebral Infarction score of ≥2a. The effect of IVT and potential treatment effect heterogeneity were analyzed using logistic regression analyses. RESULTS Of 396 patients, pre-interventional reperfusion occurred in 20 (10.0%) patients randomized to IVT with MT, and in 7 (3.6%) patients randomized to MT alone. Receiving IVT favored the occurrence of pre-interventional reperfusion (adjusted OR 2.91, 95% CI 1.23 to 6.87). There was no IVT treatment effect heterogeneity on the occurrence of pre-interventional reperfusion with different strata of Randomization-to-Groin-Puncture time (p for interaction=0.33), although the effect tended to be stronger in patients with a Randomization-to-Groin-Puncture time >28 min (adjusted OR 4.65, 95% CI 1.16 to 18.68). There were no significant differences in rates of functional outcomes between patients with and without pre-interventional reperfusion. CONCLUSION Even for patients with proximal large vessel occlusions and direct access to MT, IVT resulted in an absolute increase of 6% in rates of pre-interventional reperfusion. The influence of time strata on the occurrence of pre-interventional reperfusion should be studied further in an individual patient data meta-analysis of comparable trials. TRIAL REGISTRATION NUMBER clinicaltrials.gov NCT03192332.enStroke Thrombectomy Thrombolysis600 - Technology::610 - Medicine & healtharticle10.48350/1749353639643310.1136/jnis-2022-019585