Intravenous thrombolysis improves recanalization results irrespective of the mechanical thrombectomy technique in acute ischemic stroke.

IF 8.7 2区 医学 Q1 CLINICAL NEUROLOGY
International Journal of Stroke Pub Date : 2025-08-01 Epub Date: 2025-04-12 DOI:10.1177/17474930251337054
Pauline Cousin, Giuseppe Scopelliti, Alice le Berre, Joseph Benzakoun, Nicolas Bricout, Laurence Legrand, Guillaume Turc, Charlotte Cordonnier, Catherine Oppenheim, Olivier Naggara, Hilde Henon, Wagih Ben Hassen
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引用次数: 0

Abstract

Introduction: Post hoc analysis of recent trials comparing bridging therapy to endovascular therapy (EVT) alone reported improved recanalization results with bridging therapy. It remains uncertain whether the positive effect of prior intravenous thrombolysis (IVT) is consistent across all mechanical thrombectomy first-line techniques (aspiration, stent-retriever, or combination of both) currently in use. In this study, we aimed to evaluate the consistency of IVT's beneficial impact on different mechanical thrombectomy techniques.

Methods: Data were extracted from prospective registries, including consecutive acute ischemic stroke patients treated with EVT between January 2015 and October 2022. Patients included had anterior circulation large vessel occlusion and were treated with EVT, with or without prior IVT. A propensity score-weighted analysis was performed to measure the effect of IVT on recanalization results across different EVT techniques.

Results: A total of 2650 patients (mean age 70 ± 15 years, 47% males) were included, 1400 in the bridging group and 1250 in the EVT alone group. Bridging group demonstrated higher rates of successful recanalization (eTICI ⩾ 2B) (odds ratio (OR) = 1.78, 95% confidence interval (CI): [1.52-2.1]). This result was consistent across all EVT first-line techniques: aspiration (OR = 1.81; 95% CI: [1.3-2.6], p = 0.01); stent-retriever (OR = 1.64; 95% CI: [1.2-2.2]) and combined technique (OR = 1.94; 95% CI: [1.6-2.4]). In addition, fewer retrieval attempts were needed in the bridging group (OR = 1.26, 95% CI: [1.04-1.4]), with a consistent effect across different EVT techniques.

Conclusion: IVT significantly improves recanalization results of EVT in patients with acute ischemic stroke, regardless of employed mechanical thrombectomy technique.

在急性缺血性脑卒中中,静脉溶栓可以改善再通效果,而不考虑机械取栓技术。
近期比较桥接治疗与单独血管内治疗(EVT)的试验的事后分析报告了桥接治疗改善再通效果。目前尚不确定是否既往静脉溶栓(IVT)的积极作用在目前使用的所有机械取栓一线技术(抽吸、施特利沃或两者联合)中是一致的。在本研究中,我们旨在评估IVT对不同机械取栓技术的有益影响的一致性。方法数据来自前瞻性登记,包括2015年1月至2022年10月期间连续接受EVT治疗的急性缺血性脑卒中患者。纳入的患者有前循环大血管闭塞,并接受EVT治疗,有或没有IVT。采用倾向评分加权分析来衡量IVT对不同EVT技术再通结果的影响。结果共纳入2650例患者(平均年龄70±15岁,男性47%),其中桥接组1400例,单纯EVT组1250例。桥接组再通成功率更高(eTICI≥2B) (OR=1.78, 95%CI[1.52-2.1])。这一结果在所有EVT一线技术中是一致的:抽吸(OR=1.81;95% CI[1.3 ~ 2.6], p=0.01);Stentriever (OR = 1.64;95%CI[1.2-2.2])和联合技术(OR=1.94;95%置信区间[1.6 - -2.4])。此外,桥接组所需的检索次数较少(OR = 1.26, 95% CI[1.04-1.4]),不同EVT技术的效果一致。结论无论采用何种机械取栓技术,静脉溶栓均可显著改善急性缺血性脑卒中患者EVT再通效果。
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
International Journal of Stroke
International Journal of Stroke 医学-外周血管病
CiteScore
13.90
自引率
6.00%
发文量
132
审稿时长
6-12 weeks
期刊介绍: The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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