{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T03:38:59Z","timestamp":1768966739654,"version":"3.49.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100020192","name":"Medtronic Europe","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020192","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009068","name":"University of Bern","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009068","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Clin Neuroradiol"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>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\u202f+\u2009EVT) versus thrombectomy alone (EVT alone).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>In this secondary analysis of the SWIFT DIRECT trial, comparing IVT\u202f+\u2009EVT versus EVT alone, treatment effect and its heterogeneity were assessed with rates of pre-interventional reperfusion (eTICI\u00a02a\u20133) and successful post-interventional reperfusion (eTICI of\u00a02b\u20133) 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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>197 of the initial 408 trial participants were included in this secondary analysis, of which 52% received IVT\u202f+\u2009EVT. SVS was present in 92% of the participants (<jats:italic>n<\/jats:italic>\u202f=\u2009181). There was no evidence for treatment effect heterogeneity regarding the post-interventional radiological and clinical effects of IVT\u202f+\u2009EVT versus EVT alone with strata of SVS. In SVS+\u2009participants, IVT favored pre-interventional reperfusion (aOR\u00a07.95, 95% CI 1.42\u201344.46), whereas in SVS-patients, it did not (<jats:italic>P<\/jats:italic>\u00a0for interaction\u202f=\u20090.02). The individual SVS characteristics showed no significant associations with outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Presence of SVS does not seem to modify the effect of IVT\u202f+\u2009EVT 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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00062-025-01501-y","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T04:21:00Z","timestamp":1740025260000},"page":"483-493","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Susceptibility Vessel Sign and Intravenous Alteplase in Stroke Patients Treated with Thrombectomy"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5911-7957","authenticated-orcid":false,"given":"Morin","family":"Beyeler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1331-705X","authenticated-orcid":false,"given":"Roman","family":"Rohner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petra","family":"Ij\u00e4s","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omer F.","family":"Eker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christophe","family":"Cognard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Romain","family":"Bourcier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Igor","family":"Sibon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaux","family":"Lefebvre","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S\u00e9bastien","family":"Richard","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arturo","family":"Consoli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sol\u00e8ne","family":"Moulin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marielle","family":"Ernst","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Ribo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charlotte","family":"Barbier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Omid","family":"Nikoubashman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David S.","family":"Liebeskind","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martina B.","family":"Goeldlin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eike I.","family":"Piechowiak","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"B\u00fctikofer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Gralla","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0521-4051","authenticated-orcid":false,"given":"Urs","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9177-2289","authenticated-orcid":false,"given":"Johannes","family":"Kaesmacher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the SWIFT DIRECT investigators","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"1501_CR1","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.110.605576","volume-title":"CT and MRI Early Vessel Signs Reflect Clot Composition in Acute Stroke. 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Two-layered susceptibility vessel sign and high overestimation ratio on MRI are predictive of cardioembolic stroke. am J Neuroradiol. 2019;40(1):65\u20137. https:\/\/doi.org\/10.3174\/ajnr.A5865.","journal-title":"am J Neuroradiol"}],"container-title":["Clinical Neuroradiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00062-025-01501-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00062-025-01501-y\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00062-025-01501-y.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,24]],"date-time":"2025-09-24T13:04:06Z","timestamp":1758719046000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00062-025-01501-y"}},"subtitle":["A\u00a0Secondary Analysis of the SWIFT DIRECT Trial"],"short-title":[],"issued":{"date-parts":[[2025,2,20]]},"references-count":37,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2025,9]]}},"alternative-id":["1501"],"URL":"https:\/\/doi.org\/10.1007\/s00062-025-01501-y","relation":{},"ISSN":["1869-1439","1869-1447"],"issn-type":[{"value":"1869-1439","type":"print"},{"value":"1869-1447","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,20]]},"assertion":[{"value":"29 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"14 January 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 February 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"M.\u00a0Beyeler reports research support from the \u201cKurt und Senta Hermann-Stiftung\u201d, the Department of Neurology, Inselspital, Bern University Hospital and the University of Bern, Switzerland. R.\u00a0Rohner reports grants from the Swiss Heart Association, Gottfried and Julia Bangerter-Rhyner-Foundation, and the Department of Teaching and Research by the Insel Gruppe AG. M.B.\u00a0Goeldlin reports grants from Swiss Academy of Medical Sciences\/Bangerter-Rhyner-Foundation, Swiss Stroke Society, European Stroke Organization, Mittelbauvereinigung der Universit\u00e4t Bern and Inselgruppe AG. Congress grants from European Academy of Neurology and Pfizer (outside the submitted work). U.\u00a0Fischer reported research support of the Swiss National Science Foundation and the Swiss Heart Foundation; PI of the ELAN trial, Co-PI of the DISTAL, TECNO, SWIFT DIRECT and SWITCH trial; research grants from Medtronic (BEYOND SWIFT, SWIFT DIRECT) and from Stryker, Rapid medical, Penumbra and Phenox (DISTAL); consultancies for Medtronic, Stryker, and CSL Behring (fees paid to institution); participation in an advisory board for Alexion\/Portola, Boehringer Ingelheim, Biogen and Acthera (fees paid to institution); member of a\u00a0clinical event committee (CEC) of the COATING study (Phenox) and member of the data and safety monitoring committee (DSMB) of the TITAN, LATE_MT and IN EXTREMIS trials; Presidency of the Swiss Neurological Society. J.\u00a0Kaesmacher reports grants from the Swiss Academy of Medical Sciences\/Bangerter Foundation, Swiss Stroke Society, and Clinical Trials Unit Bern during the conduct of the study. E.I.\u00a0Piechowiak reported research support of the Swiss National Science Foundation. P.\u00a0Ij\u00e4s, O.F.\u00a0Eker, C.\u00a0Cognard, R.\u00a0Bourcier, I.\u00a0Sibon, M.\u00a0Lefebvre, S.\u00a0Richard, A.\u00a0Consoli, S.\u00a0Moulin, M.\u00a0Ernst, M.\u00a0Ribo, C.\u00a0Barbier, O.\u00a0Nikoubashman, D.S.\u00a0Liebeskind, L.\u00a0B\u00fctikofer and J.\u00a0Gralla declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The SWIFT DIRECT trial was a prospective randomized controlled trial for which 408 patients were randomized between November 29, 2017 and May 07, 2021. This secondary analysis was conducted according to the SWIFT DIRECT trial protocol and its corresponding revisions, which were approved by central and local ethics committees and research boards. Participants or their legal representatives had to provide written informed consent. In certain countries delayed informed consent after inclusion granted by an independent physician in emergency circumstances was used. The SWIFT DIRECT trial followed the Consolidated Standards of Reporting Trials (CONSORT) guidelines.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}