Bridging the Gap: Improving Acute Ischemic Stroke Outcomes with Intravenous Thrombolysis Prior to Mechanical Thrombectomy.

IF 3.2 Q2 CLINICAL NEUROLOGY Neurology International Pub Date : 2024-10-22 DOI:10.3390/neurolint16060090
Jessica Seetge, Balázs Cséke, Zsófia Nozomi Karádi, Edit Bosnyák, László Szapáry
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Abstract

Background/objectives: Current guidelines recommend intravenous thrombolysis (IVT) followed by mechanical thrombectomy (MT) for patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). This combined approach, known as bridging therapy (BT), is believed to increase the likelihood of a favorable functional outcome when administered within 4.5 h of symptom onset. However, the benefits of BT over direct mechanical thrombectomy (d-MT) remain debated. This study aimed to compare the outcomes of AIS-LVO patients undergoing MT within 6 h of symptom onset, with and without prior IVT.

Methods: Within the prospective Transzlációs Idegtudományi Nemzeti Laboratórium (TINL) STROKE-registry, AIS-LVO patients admitted to the Department of Neurology, University of Pécs between February 2023 and June 2024 were investigated. The primary endpoint was the proportion of patients reaching functional independence at 90 days, defined as a modified Rankin Scale (mRS) score of 0-2. Secondary endpoints included clinical improvement at 72 h (National Institute of Health Stroke Scale [NIHSS] score of ≤1 or a change from baseline [ΔNIHSS] of ≥4) and successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] score ≥ 2). Safety outcomes were evaluated based on thrombus migration and intracranial hemorrhage (ICH). Results were compared using linear and logistic regression analyses adjusted for baseline variables.

Results: Of 82 patients, 51 (62.2%) received BT, while 31 (37.8%) underwent d-MT. The BT group showed a significantly higher rate of functional independence (45.7% vs. 17.2%, p = 0.014) and a lower 90-day mortality rate (13.7% vs. 35.5%, p = 0.029). Multivariate analysis revealed that IVT was independently associated with favorable functional outcomes (p = 0.011) and reduced mortality (p = 0.021). No significant differences were observed in terms of clinical improvement at 72 h, successful recanalization, thrombus migration, or hemorrhagic transformation between the groups.

Conclusions: This study supports current guidelines recommending BT for thrombectomy-eligible AIS-LVO patients, offering new insights into the ongoing clinical debate.

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弥合差距:在机械血栓切除术前进行静脉溶栓,改善急性缺血性脑卒中的治疗效果。
背景/目的:目前的指南建议对大血管闭塞(LVO)引起的急性缺血性卒中(AIS)患者先进行静脉溶栓(IVT),然后再进行机械取栓(MT)。这种被称为桥接疗法(BT)的联合方法被认为在症状出现后 4.5 小时内实施可增加获得良好功能预后的可能性。然而,与直接机械血栓切除术(d-MT)相比,桥接疗法的优势仍存在争议。本研究旨在比较在症状出现后6小时内接受MT治疗的AIS-LVO患者的预后,以及是否事先进行了IVT治疗:在前瞻性的Transzlációs Idegtudományi Nemzeti Laboratórium(TINL)STROKE登记系统中,对2023年2月至2024年6月期间佩奇大学神经内科收治的AIS-LVO患者进行了调查。主要终点是90天后达到功能独立的患者比例,即修改后的Rankin量表(mRS)评分为0-2分。次要终点包括72小时后的临床改善(美国国立卫生研究院卒中量表[NIHSS]评分≤1或与基线相比[ΔNIHSS]变化≥4)和成功再通(改良脑梗塞溶栓评分≥2)。根据血栓迁移和颅内出血(ICH)评估安全性结果。结果通过调整基线变量后的线性和逻辑回归分析进行比较:82名患者中,51人(62.2%)接受了BT治疗,31人(37.8%)接受了d-MT治疗。BT 组的功能独立率明显更高(45.7% 对 17.2%,P = 0.014),90 天死亡率更低(13.7% 对 35.5%,P = 0.029)。多变量分析显示,IVT与良好的功能预后(p = 0.011)和降低的死亡率(p = 0.021)独立相关。在72小时临床改善、成功再通、血栓移位或出血转化方面,两组间未观察到明显差异:本研究支持当前指南推荐对符合血栓切除条件的 AIS-LVO 患者进行 BT 治疗,为当前的临床争论提供了新的见解。
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来源期刊
Neurology International
Neurology International CLINICAL NEUROLOGY-
CiteScore
3.70
自引率
3.30%
发文量
69
审稿时长
11 weeks
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