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

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)