The pivotal role of timing of intravenous thrombolysis bridging treatment prior to endovascular thrombectomy.

IF 5.4 3区材料科学 Q2 CHEMISTRY, PHYSICAL ACS Applied Energy Materials Pub Date : 2023-12-15 eCollection Date: 2023-01-01 DOI:10.1177/17562864231216637

Jeremy Molad, Hen Hallevi, Estelle Seyman, Einor Ben-Assayag, Tali Jonas-Kimchi, Udi Sadeh, Ofer Rotschild, Naaem Simaan, Anat Horev, Jose Cohen, Ronen R Leker, Asaf Honig

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Abstract

Background: The role of intravenous thrombolysis (IVT) as bridging treatment prior to endovascular thrombectomy (EVT) is under debate and better patient selection is needed.

Objectives: As the efficacy and safety of IVT diminish with time, we aimed to examine the impact of bridging treatment within different time frames from symptom onset.

Design: A retrospective registry study.

Methods: Data were extracted from ongoing prospective EVT registries in two large tertiary centers. The current study included IVT-eligible patients with onset to door (OTD) < 4 h. We examined the efficacy and safety of bridging treatment through a comparison of the IVT + EVT group with the direct-EVT group by different time frames.

Results: In all, 408 patients (age 71.1 ± 14.6, 50.6% males) were included, among them 195 received IVT + EVT and 213 underwent direct EVT. Both groups had similar characteristics. In the IVT + EVT group only, longer OTD was associated with lower rates of favorable outcome (p = 0.021) and higher rates of hemorrhagic transformation (HT; p = 0.001). In patients with OTD ⩽ 2 h, IVT + EVT compared to direct EVT had higher rates of TICI 2b-3 (86.2% versus 80.7%, p = 0.038). In patients with OTD > 2 h, IVT + EVT had lower rates of favorable outcome (33.3% versus 56.9%, p = 0.021), worse discharge National Institutes of Health Stroke Scale [7 (2-13) versus 3 (1-8), p = 0.024], and higher rates of HT (34.0% versus 8.5%, p < 0.001).

Discussion: In this study, we found OTD times to have a significant effect on the impact of IVT bridging treatment. Our study shows that among patients with OTD < 2 h bridging treatment may be associated with higher rates of successful recanalization. By contrast, in patients with OTD > 2 h, bridging treatment was associated with worse outcomes. Further time-sensitive randomized trials are needed.

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血管内血栓切除术前静脉溶栓桥接治疗时机的关键作用。

背景：静脉溶栓（IVT）作为血管内血栓切除术（EVT）前的桥接治疗的作用还存在争议，需要更好地选择患者：由于静脉溶栓治疗的有效性和安全性会随着时间的推移而降低，因此我们旨在研究从症状出现开始的不同时间段内桥接治疗的影响：设计：一项回顾性登记研究：方法：从两家大型三级医疗中心正在进行的前瞻性 EVT 登记中提取数据。目前的研究包括符合 IVT 条件的患者，他们从发病到出院（OTD）：共纳入 408 名患者（年龄为 71.1 ± 14.6，男性占 50.6%），其中 195 人接受了 IVT + EVT，213 人直接接受了 EVT。两组患者的特征相似。仅在 IVT + EVT 组中，较长的 OTD 与较低的预后良好率（p = 0.021）和较高的出血转化率（HT；p = 0.001）相关。在 OTD ⩽ 2 小时的患者中，IVT + EVT 与直接 EVT 相比，TICI 2b-3 的比率更高（86.2% 对 80.7%，p = 0.038）。在 OTD > 2 h 的患者中，IVT + EVT 的良好预后率较低（33.3% 对 56.9%，p = 0.021），出院时美国国立卫生研究院卒中量表较差 [7 (2-13) 对 3 (1-8)，p = 0.024]，HT 发生率较高（34.0% 对 8.5%，p 讨论：在这项研究中，我们发现 OTD 时间对 IVT 桥接治疗的影响有显著影响。我们的研究表明，在 OTD 为 2 小时的患者中，桥接治疗与较差的预后相关。需要进一步开展时间敏感性随机试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Applied Energy Materials Materials Science-Materials Chemistry

CiteScore

10.30

自引率

6.20%

发文量

1368

期刊介绍： ACS Applied Energy Materials is an interdisciplinary journal publishing original research covering all aspects of materials, engineering, chemistry, physics and biology relevant to energy conversion and storage. The journal is devoted to reports of new and original experimental and theoretical research of an applied nature that integrate knowledge in the areas of materials, engineering, physics, bioscience, and chemistry into important energy applications.