Impact of bridging intravenous thrombolysis and infarct core growth rate on early neurological improvement in patients with acute anterior circulation ischemic stroke and mechanical thrombectomy.

Abstract

PurposeThe aim of this study is to assess the impact of bridging intravenous thrombolysis (IVT), infarct core growth rate (ICGR) and their interaction on neurological outcomes in patients undergoing endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) with anterior large vessel occlusion (LVO).MethodsPatients undergoing EVT due to anterior LVO (ICA to M2 branches) between 2018 and 2022 in a tertiary care center were included. Patient's baseline characteristics, peri-procedural factors of EVT and neurological outcomes were retrospectively analyzed. ICGR was determined by infarct core volume on perfusion CT divided by the time from stroke onset to imaging. Endpoints included early neurological improvement (ENI), defined as NIHSS reduction of ≥8 points after 24 h or NIHSS < 2 at discharge, and intracranial hemorrhage (ICH) on CT at 24 h.ResultsOf 205 patients, 128 (62.4%) received bridging IVT. Neither bridging IVT, ICGR, nor their interaction was significantly associated with ENI or ICH occurrence. Factors significantly associated with ENI included short groin puncture to reperfusion time (OR = 0.98, CI 0.97-0.99, p < 0.001), low pre-stroke mRS (OR = 0.76, CI 0.65-0.89, p = 0.001), and high baseline CT ASPECTS (OR = 1.15, CI 1-1.31, p = 0.049). Factors associated with reduced odds of ICH were short symptom onset to admission time (OR = 1, CI 0.998-1, p = 0.021), short groin puncture to reperfusion time (OR = 1.01, CI 1-1.02, p = 0.039), and complete reperfusion (OR 0.89, CI 0.81-0.97, p = 0.009).ConclusionNeither bridging intravenous thrombolysis, infarct core growth rate, nor their interaction significantly impacted early neurological improvement or intracranial hemorrhage rate.