Thrombolysis to Recanalization Time Affects the Benefit of Bridging Thrombolysis in Large Vessel Occlusion Patients With Successful Recanalization

IF 5 1区医学 Q1 NEUROSCIENCES

CNS Neuroscience & Therapeutics Pub Date : 2025-09-14 DOI:10.1111/cns.70579

Gao-Peng Xing, Wei Li, Chang Cui, Zi-Ai Zhao, Thanh N. Nguyen, Hui-Sheng Chen

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Abstract

Background and Purpose

The benefit of bridging intravenous thrombolysis (IVT) was conflicting in patients with large vessel occlusion (LVO) who received endovascular treatment (EVT). This study aimed to determine whether IVT to recanalization time (TRT) can affect the benefit of IVT bridging EVT.

Methods

Based on a retrospective cohort, eligible LVO patients who achieved successful recanalization after IVT bridging EVT within onset to puncture time of 7 h were enrolled and were divided into TRT ≤ 182 min and TRT > 182 min groups according to median TRT. The primary outcome was the shift in the degree of disability as measured by the modified Rankin Scale (mRS) at 90 days. The primary safety outcome was symptomatic intracranial hemorrhage (sICH). The inverse propensity of treatment weight (IPTW) was used as sensitivity analysis.

Results

A total of 83 eligible patients were enrolled in the final analysis, including 42 in the TRT ≤ 182 min and 41 in the TRT > 182 min group. There was a shift tendency toward a lower degree of functional disability on mRS score at 90 days favoring the TRT ≤ 182 min group compared to the TRT > 182 min group (adjusted OR 1.80, 95% CI 0.69–4.75, p = 0.19), which was confirmed by IPTW analysis (OR 1.73, 95% CI 1.16–2.59, p = 0.06). A numerically higher proportion of excellent functional outcome at 90 days was found in the TRT ≤ 182 min vs. TRT > 182 min group (56.8% vs. 33.8% before IPTW; 58.4% vs. 25.9% after IPTW). There was no difference in sICH between the TRT ≤ 182 min and TRT > 182 min group.

Conclusion

Among LVO patients who achieved successful recanalization after IVT bridging EVT, the benefit of IVT may be associated with TRT. This finding needs to be validated in prospective trials.

Trial Registration

This trial was registered with ClinicalTrials.gov (NCT04752735)

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溶栓至再通时间影响大血管闭塞患者成功再通桥溶栓的益处

背景与目的在大血管闭塞（LVO）患者接受血管内治疗（EVT）时，桥式静脉溶栓（IVT）的益处存在矛盾。本研究旨在确定IVT到再通时间（TRT）是否会影响IVT桥接EVT的益处。方法在回顾性队列研究的基础上，纳入符合条件且在起病至穿刺时间7 h内IVT桥接EVT后再通成功的LVO患者，根据中位TRT分为TRT≤182 min组和TRT & 182 min组。主要结局是用改良的Rankin量表（mRS）在90天测量的残疾程度的变化。主要安全终点是症状性颅内出血（siich）。采用处理权重逆倾向（IPTW）作为敏感性分析。结果最终纳入83例符合条件的患者，其中TRT≤182 min组42例，TRT >； 182 min组41例。与TRT >； 182 min组相比，TRT≤182 min组在90天mRS评分上倾向于较低的功能残疾程度（校正OR 1.80, 95% CI 0.69-4.75, p = 0.19）， IPTW分析证实了这一点（OR 1.73, 95% CI 1.16-2.59, p = 0.06）。与TRT >； 182 min组相比，TRT≤182 min组90天功能预后良好的比例更高（IPTW前56.8% vs. 33.8%； IPTW后58.4% vs. 25.9%）。TRT≤182 min组与TRT >； 182 min组siich发生率无差异。结论在IVT桥接EVT后再通成功的LVO患者中，IVT的益处可能与TRT相关。这一发现需要在前瞻性试验中得到验证。该试验已在ClinicalTrials.gov注册（NCT04752735）。

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

CNS Neuroscience & Therapeutics 医学-神经科学

CiteScore

7.30

自引率

12.70%

发文量

240

审稿时长

2 months

期刊介绍： CNS Neuroscience & Therapeutics provides a medium for rapid publication of original clinical, experimental, and translational research papers, timely reviews and reports of novel findings of therapeutic relevance to the central nervous system, as well as papers related to clinical pharmacology, drug development and novel methodologies for drug evaluation. The journal focuses on neurological and psychiatric diseases such as stroke, Parkinson’s disease, Alzheimer’s disease, depression, schizophrenia, epilepsy, and drug abuse.