Jeremy Molad, Hen Hallevi, Estelle Seyman, Einor Ben-Assayag, Tali Jonas-Kimchi, Udi Sadeh, Ofer Rotschild, Naaem Simaan, Anat Horev, Jose Cohen, Ronen R Leker, Asaf Honig
{"title":"血管内血栓切除术前静脉溶栓桥接治疗时机的关键作用。","authors":"Jeremy Molad, Hen Hallevi, Estelle Seyman, Einor Ben-Assayag, Tali Jonas-Kimchi, Udi Sadeh, Ofer Rotschild, Naaem Simaan, Anat Horev, Jose Cohen, Ronen R Leker, Asaf Honig","doi":"10.1177/17562864231216637","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The role of intravenous thrombolysis (IVT) as bridging treatment prior to endovascular thrombectomy (EVT) is under debate and better patient selection is needed.</p><p><strong>Objectives: </strong>As the efficacy and safety of IVT diminish with time, we aimed to examine the impact of bridging treatment within different time frames from symptom onset.</p><p><strong>Design: </strong>A retrospective registry study.</p><p><strong>Methods: </strong>Data were extracted from ongoing prospective EVT registries in two large tertiary centers. The current study included IVT-eligible patients with onset to door (OTD) < 4 h. We examined the efficacy and safety of bridging treatment through a comparison of the IVT + EVT group with the direct-EVT group by different time frames.</p><p><strong>Results: </strong>In all, 408 patients (age 71.1 ± 14.6, 50.6% males) were included, among them 195 received IVT + EVT and 213 underwent direct EVT. Both groups had similar characteristics. In the IVT + EVT group only, longer OTD was associated with lower rates of favorable outcome (<i>p</i> = 0.021) and higher rates of hemorrhagic transformation (HT; <i>p</i> = 0.001). In patients with OTD ⩽ 2 h, IVT + EVT compared to direct EVT had higher rates of TICI 2b-3 (86.2% <i>versus</i> 80.7%, <i>p</i> = 0.038). In patients with OTD > 2 h, IVT + EVT had lower rates of favorable outcome (33.3% <i>versus</i> 56.9%, <i>p</i> = 0.021), worse discharge National Institutes of Health Stroke Scale [7 (2-13) <i>versus</i> 3 (1-8), <i>p</i> = 0.024], and higher rates of HT (34.0% <i>versus</i> 8.5%, <i>p</i> < 0.001).</p><p><strong>Discussion: </strong>In this study, we found OTD times to have a significant effect on the impact of IVT bridging treatment. Our study shows that among patients with OTD < 2 h bridging treatment may be associated with higher rates of successful recanalization. By contrast, in patients with OTD > 2 h, bridging treatment was associated with worse outcomes. Further time-sensitive randomized trials are needed.</p>","PeriodicalId":22980,"journal":{"name":"Therapeutic Advances in Neurological Disorders","volume":"16 ","pages":"17562864231216637"},"PeriodicalIF":4.7000,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10725133/pdf/","citationCount":"0","resultStr":"{\"title\":\"The pivotal role of timing of intravenous thrombolysis bridging treatment prior to endovascular thrombectomy.\",\"authors\":\"Jeremy Molad, Hen Hallevi, Estelle Seyman, Einor Ben-Assayag, Tali Jonas-Kimchi, Udi Sadeh, Ofer Rotschild, Naaem Simaan, Anat Horev, Jose Cohen, Ronen R Leker, Asaf Honig\",\"doi\":\"10.1177/17562864231216637\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The role of intravenous thrombolysis (IVT) as bridging treatment prior to endovascular thrombectomy (EVT) is under debate and better patient selection is needed.</p><p><strong>Objectives: </strong>As the efficacy and safety of IVT diminish with time, we aimed to examine the impact of bridging treatment within different time frames from symptom onset.</p><p><strong>Design: </strong>A retrospective registry study.</p><p><strong>Methods: </strong>Data were extracted from ongoing prospective EVT registries in two large tertiary centers. The current study included IVT-eligible patients with onset to door (OTD) < 4 h. We examined the efficacy and safety of bridging treatment through a comparison of the IVT + EVT group with the direct-EVT group by different time frames.</p><p><strong>Results: </strong>In all, 408 patients (age 71.1 ± 14.6, 50.6% males) were included, among them 195 received IVT + EVT and 213 underwent direct EVT. Both groups had similar characteristics. In the IVT + EVT group only, longer OTD was associated with lower rates of favorable outcome (<i>p</i> = 0.021) and higher rates of hemorrhagic transformation (HT; <i>p</i> = 0.001). In patients with OTD ⩽ 2 h, IVT + EVT compared to direct EVT had higher rates of TICI 2b-3 (86.2% <i>versus</i> 80.7%, <i>p</i> = 0.038). In patients with OTD > 2 h, IVT + EVT had lower rates of favorable outcome (33.3% <i>versus</i> 56.9%, <i>p</i> = 0.021), worse discharge National Institutes of Health Stroke Scale [7 (2-13) <i>versus</i> 3 (1-8), <i>p</i> = 0.024], and higher rates of HT (34.0% <i>versus</i> 8.5%, <i>p</i> < 0.001).</p><p><strong>Discussion: </strong>In this study, we found OTD times to have a significant effect on the impact of IVT bridging treatment. Our study shows that among patients with OTD < 2 h bridging treatment may be associated with higher rates of successful recanalization. By contrast, in patients with OTD > 2 h, bridging treatment was associated with worse outcomes. Further time-sensitive randomized trials are needed.</p>\",\"PeriodicalId\":22980,\"journal\":{\"name\":\"Therapeutic Advances in Neurological Disorders\",\"volume\":\"16 \",\"pages\":\"17562864231216637\"},\"PeriodicalIF\":4.7000,\"publicationDate\":\"2023-12-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10725133/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Therapeutic Advances in Neurological Disorders\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/17562864231216637\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q1\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Therapeutic Advances in Neurological Disorders","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/17562864231216637","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/1/1 0:00:00","PubModel":"eCollection","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
The pivotal role of timing of intravenous thrombolysis bridging treatment prior to endovascular thrombectomy.
Background: The role of intravenous thrombolysis (IVT) as bridging treatment prior to endovascular thrombectomy (EVT) is under debate and better patient selection is needed.
Objectives: As the efficacy and safety of IVT diminish with time, we aimed to examine the impact of bridging treatment within different time frames from symptom onset.
Design: A retrospective registry study.
Methods: Data were extracted from ongoing prospective EVT registries in two large tertiary centers. The current study included IVT-eligible patients with onset to door (OTD) < 4 h. We examined the efficacy and safety of bridging treatment through a comparison of the IVT + EVT group with the direct-EVT group by different time frames.
Results: In all, 408 patients (age 71.1 ± 14.6, 50.6% males) were included, among them 195 received IVT + EVT and 213 underwent direct EVT. Both groups had similar characteristics. In the IVT + EVT group only, longer OTD was associated with lower rates of favorable outcome (p = 0.021) and higher rates of hemorrhagic transformation (HT; p = 0.001). In patients with OTD ⩽ 2 h, IVT + EVT compared to direct EVT had higher rates of TICI 2b-3 (86.2% versus 80.7%, p = 0.038). In patients with OTD > 2 h, IVT + EVT had lower rates of favorable outcome (33.3% versus 56.9%, p = 0.021), worse discharge National Institutes of Health Stroke Scale [7 (2-13) versus 3 (1-8), p = 0.024], and higher rates of HT (34.0% versus 8.5%, p < 0.001).
Discussion: In this study, we found OTD times to have a significant effect on the impact of IVT bridging treatment. Our study shows that among patients with OTD < 2 h bridging treatment may be associated with higher rates of successful recanalization. By contrast, in patients with OTD > 2 h, bridging treatment was associated with worse outcomes. Further time-sensitive randomized trials are needed.
期刊介绍:
Therapeutic Advances in Neurological Disorders is a peer-reviewed, open access journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of neurology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in neurology, providing a forum in print and online for publishing the highest quality articles in this area.