Sistema de Salut de Catalunya
Institut Català de la Salut
[Beyeler M] Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. Graduate School for Health Sciences, University of Bern, Bern, Switzerland. [Rohner R] Graduate School for Health Sciences, University of Bern, Bern, Switzerland. Institute for Diagnostic and Interventional Neuroradiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. [Ijäs P] Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland. [Eker OF] Department of Vascular Neurology, Hospices Civils de Lyon, Lyon, France. [Cognard C] Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France. [Bourcier R] Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nantes, L’institut du thorax, Nantes, Pays de la Loire, France. [Ribo M] Servei de Neuroradiologia Intervencionista, Vall d’Hebron Hospital Universitari, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2025-10-16T06:26:17Z
2025-10-16T06:26:17Z
2025-09
Intravenous alteplase; Ischemic stroke; Susceptibility vessel sign
Alteplasa intravenosa; Ictus isquémico; Señal de vaso de susceptibilidad
Alteplasa intravenosa; Ictus isquèmic; Senyal de vas de susceptibilitat
Background The susceptibility vessel sign (SVS) on baseline MRI in acute ischemic stroke patients has been associated with better outcomes post-thrombectomy. This study aimed to investigate whether the presence of the SVS modifies the treatment effect of intravenous thrombolysis plus endovascular thrombectomy (IVT + EVT) versus thrombectomy alone (EVT alone). Methods In this secondary analysis of the SWIFT DIRECT trial, comparing IVT + EVT versus EVT alone, treatment effect and its heterogeneity were assessed with rates of pre-interventional reperfusion (eTICI 2a–3) and successful post-interventional reperfusion (eTICI of 2b–3) according to the SVS status using adjusted multivariable logistic regression. Secondary objectives were to analyze whether the presence of SVS or its individual characteristics (location, length, width, overestimation ratio, two-layered sign) were associated with outcomes. Results 197 of the initial 408 trial participants were included in this secondary analysis, of which 52% received IVT + EVT. SVS was present in 92% of the participants (n = 181). There was no evidence for treatment effect heterogeneity regarding the post-interventional radiological and clinical effects of IVT + EVT versus EVT alone with strata of SVS. In SVS+ participants, IVT favored pre-interventional reperfusion (aOR 7.95, 95% CI 1.42–44.46), whereas in SVS-patients, it did not (P for interaction = 0.02). The individual SVS characteristics showed no significant associations with outcomes. Conclusion Presence of SVS does not seem to modify the effect of IVT + EVT versus EVT alone. In SVS+ patients, IVT might improve pre-interventional reperfusion. There is insufficient evidence to recommend using SVS to inform IVT decisions prior to EVT.
Open access funding provided by University of Bern.
Article
Published version
English
Malalties cerebrovasculars - Tractament; Fibrinolítics - Ús terapèutic; Vasos sanguinis - Cirurgia; Imatgeria per ressonància magnètica; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Surgical Procedures, Operative::Cardiovascular Surgical Procedures::Vascular Surgical Procedures::Thrombectomy; DISEASES::Nervous System Diseases::Central Nervous System Diseases::Brain Diseases::Cerebrovascular Disorders::Stroke; Other subheadings::Other subheadings::/therapy; CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Fibrin Modulating Agents::Fibrinolytic Agents; Other subheadings::Other subheadings::Other subheadings::/administration & dosage; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Tomography::Magnetic Resonance Imaging; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::intervenciones quirúrgicas::procedimientos quirúrgicos cardiovasculares::procedimientos quirúrgicos vasculares::trombectomía; ENFERMEDADES::enfermedades del sistema nervioso::enfermedades del sistema nervioso central::enfermedades cerebrales::trastornos cerebrovasculares::accidente cerebrovascular; Otros calificadores::Otros calificadores::/terapia; COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::mecanismos moleculares de acción farmacológica::moduladores de la fibrina::fibrinolíticos; Otros calificadores::Otros calificadores::Otros calificadores::/administración & dosificación; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::tomografía::imagen por resonancia magnética
Springer
Clinical Neuroradiology;35
10.1007/s00062-025-01501-y
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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