Relationship Between Thrombolysis-to-Puncture Time and Outcomes of Endovascular Thrombectomy in Acute Ischemic Stroke.

IF 3.2 Q3 CLINICAL NEUROLOGY

Neurology. Clinical practice Pub Date : 2025-08-01 Epub Date: 2025-07-11 DOI:10.1212/CPJ.0000000000200434

Xu Tong, Baixue Jia, Gaoting Ma, Xuelei Zhang, Jens Fiehler, Fabian Flottmann, Matthias Bechstein, Gabriel Broocks, Uta Hanning, Helge C Kniep, Götz Thomalla, Milani Deb-Chatterji, Gerhard Schön, Yijun Zhang, Feng Gao, Ning Ma, Dapeng Mo, Zhongrong Miao, Lukas Meyer

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Abstract

Background and objectives: Intravenous thrombolysis (IVT) followed by endovascular thrombectomy (EVT) improves functional outcomes in patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). There are limited data on the effect of thrombolysis-to-puncture time (TTP) on outcomes in patients with AIS undergoing IVT plus EVT.

Methods: We selected 1,104 patients receiving IVT + EVT for anterior circulation LVO stroke from 2 prospective nationwide registries (259 cases from ANGEL-ACT in China: November 2017 to March 2019, 845 cases from German Stroke Registry-Endovascular Treatment in Germany: June 2015 to December 2019). Based on the TTP, eligible patients were divided into 4 groups (≤30 min, 31-50 min, 51-70 min, and >70 min). The radiologic and clinical outcomes (e.g., successful recanalization [modified Thrombolysis in Cerebral Infarction score of 2b-3] at final angiogram, modified Rankin Scale [mRS] score of 0-2 at 90 days, any intracranial hemorrhage [ICH], and symptomatic ICH within 24 hours) among the 4 groups were compared by χ² tests for trend and using multivariable logistic regression models.

Results: In the 4 groups from ≤30 min to >70 min, 226, 282, 230, and 366 patients were included, respectively. An increased TTP was associated with a lower chance of successful recanalization (p = 0.016) and mRS score 0-2 (p = 0.002). Compared with the group of ≤30 min, the group of >70 min was less likely to achieve successful recanalization (adjusted odds ratio [OR] = 0.47, 95% CI 0.25-0.89) and the groups of 50-70 min and >70 min had a reduced probability of mRS score 0-2 (adjusted OR = 0.50, 95% CI 0.33-0.78; adjusted OR = 0.56, 95% CI 0.37-0.85). No significant differences were found for any ICH or symptomatic ICH among the 4 groups after adjustment with potential confounders.

Discussion: Delay from thrombolysis to puncture should be minimized when considering bridging IVT before EVT for patients with AIS due to anterior circulation LVO. Further studies are warranted to verify and expand on these findings.

Trial registration information: ClinicalTrials.gov, NCT03370939 and NCT03356392.

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急性缺血性卒中溶栓至穿刺时间与血管内取栓效果的关系。

背景和目的：静脉溶栓（IVT）后血管内取栓（EVT）可改善由大血管闭塞（LVO）引起的急性缺血性卒中（AIS）患者的功能结局。关于溶栓至穿刺时间（TTP）对AIS患者接受IVT + EVT的预后影响的数据有限。方法：我们从2个前瞻性全国登记处选择了1104例接受IVT + EVT治疗前循环LVO卒中的患者（259例来自中国ANGEL-ACT: 2017年11月至2019年3月，845例来自德国卒中登记处-血管内治疗：2015年6月至2019年12月）。根据TTP将符合条件的患者分为≤30 min、31 ~ 50 min、51 ~ 70 min和bb0 ~ 70 min 4组。采用χ2趋势检验和多变量logistic回归模型比较4组患者的影像学和临床预后（如终期血管造影时再通成功[改良脑梗死溶栓评分为2 ~ 3分]、90 d时改良Rankin量表评分为0 ~ 2分、有无颅内出血（ICH）、24小时内有症状的脑出血）。结果：≤30min ~≤70min 4组，分别纳入226例、282例、230例、366例患者。TTP升高与再通成功几率降低（p = 0.016）和mRS评分0-2 （p = 0.002）相关。与≤30 min组相比，>70 min组再通成功的可能性较低（校正优势比[OR] = 0.47, 95% CI 0.25-0.89）， 50-70 min组和>70 min组mRS评分0-2的概率较低(校正OR = 0.50, 95% CI 0.33-0.78；调整OR = 0.56, 95% CI 0.37-0.85)。在对潜在混杂因素进行校正后，四组之间没有发现任何脑出血或症状性脑出血的显著差异。讨论：对于前循环LVO导致的AIS患者，在EVT前考虑桥接IVT时，应尽量减少从溶栓到穿刺的延迟。需要进一步的研究来验证和扩展这些发现。试验注册信息：ClinicalTrials.gov， NCT03370939和NCT03356392。

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

Neurology. Clinical practice CLINICAL NEUROLOGY-

CiteScore

4.00

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0.00%

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期刊介绍： Neurology® Genetics is an online open access journal publishing peer-reviewed reports in the field of neurogenetics. The journal publishes original articles in all areas of neurogenetics including rare and common genetic variations, genotype-phenotype correlations, outlier phenotypes as a result of mutations in known disease genes, and genetic variations with a putative link to diseases. Articles include studies reporting on genetic disease risk, pharmacogenomics, and results of gene-based clinical trials (viral, ASO, etc.). Genetically engineered model systems are not a primary focus of Neurology® Genetics, but studies using model systems for treatment trials, including well-powered studies reporting negative results, are welcome.