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
{"title":"Bridging the Gap: Improving Acute Ischemic Stroke Outcomes with Intravenous Thrombolysis Prior to Mechanical Thrombectomy.","authors":"Jessica Seetge, Balázs Cséke, Zsófia Nozomi Karádi, Edit Bosnyák, László Szapáry","doi":"10.3390/neurolint16060090","DOIUrl":null,"url":null,"abstract":"<p><strong>Background/objectives: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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%, <i>p</i> = 0.014) and a lower 90-day mortality rate (13.7% vs. 35.5%, <i>p</i> = 0.029). Multivariate analysis revealed that IVT was independently associated with favorable functional outcomes (<i>p</i> = 0.011) and reduced mortality (<i>p</i> = 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.</p><p><strong>Conclusions: </strong>This study supports current guidelines recommending BT for thrombectomy-eligible AIS-LVO patients, offering new insights into the ongoing clinical debate.</p>","PeriodicalId":19130,"journal":{"name":"Neurology International","volume":"16 6","pages":"1189-1202"},"PeriodicalIF":3.2000,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11503436/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurology International","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.3390/neurolint16060090","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

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.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
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。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
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
期刊最新文献
Sensitization and Habituation of Hyper-Excitation to Constant Presentation of Pattern-Glare Stimuli. Evolution of Cognitive Disorders in Patients with Mild Cognitive Impairment (MCI) After Ischemic Stroke: Secondary Data Analysis from the Improved Health Care in Neurology and Psychiatry-Longer Life (IHCNP) Study. Macamides as Potential Therapeutic Agents in Neurological Disorders. Slow Subcutaneous Release of Glatiramer Acetate or CD40-Targeting Peptide KGYY6 Is More Advantageous in Treating Ongoing Experimental Autoimmune Encephalomyelitis. Mindfulness-Based Interventions and the Hypothalamic-Pituitary-Adrenal Axis: A Systematic Review.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1