Neurology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, Chongqing, China.
Neurology, Army Medical University Xinqiao Hospital Department of Neurology, Chongqing, Chongqing, China.
J Neurointerv Surg. 2024 Jul 16;16(8):794-800. doi: 10.1136/jnis-2023-020361.
Endovascular treatment (EVT) is a well-established approach for acute ischemic stroke. Whether bridging intravenous thrombolysis (IVT) before EVT confers any benefits remains uncertain. The objective of the study was to compare the efficacy and safety of direct EVT with or without bridging IVT in patients with acute basilar artery occlusion (BAO).
This multicenter cohort study enrolled 647 patients with acute BAO who underwent either bridging IVT before EVT or direct EVT from the BASILAR registry. The primary outcome was an independent functional outcome measured by the modified Rankin Scale (mRS) score of 0-2. Secondary outcomes included excellent functional outcome (mRS 0-1), favorable functional outcome (mRS 0-3), and mortality rate at 90 days, as well as symptomatic intracranial hemorrhage (sICH), and successful reperfusion between the two treatment groups.
Direct EVT and bridging IVT before EVT exhibited similar primary outcomes (27.3% vs 27.7%, respectively) and distributions of mRS scores at 90 days. Moreover, rates of sICH and 90-day mortality were not significantly different between the two groups (7.3% vs 6.0%, adjusted OR (aOR) 0.79, 95% CI 0.34 to 1.86, P=0.84 for sICH; 46.8% vs 43.7%, aOR 0.86, 95% CI 0.54 to 1.38, P=0.53 for mortality).
Among patients with acute BAO, functional outcomes were similar between those treated with bridging IVT before EVT and those treated with direct EVT, and there was no difference between the two groups in terms of sICH and mortality rates.
血管内治疗（EVT）是急性缺血性脑卒中的一种成熟方法。在 EVT 之前桥接静脉溶栓（IVT）是否有任何益处仍不确定。本研究的目的是比较急性基底动脉闭塞（BAO）患者行直接 EVT 与桥接 IVT 前 EVT 的疗效和安全性。
本多中心队列研究纳入了来自 BASILAR 登记处的 647 例急性 BAO 患者，他们接受了桥接 IVT 前 EVT 或直接 EVT。主要结局是采用改良 Rankin 量表（mRS）评分 0-2 评估的独立功能结局。次要结局包括良好的功能结局（mRS 0-1）、有利的功能结局（mRS 0-3）和 90 天死亡率，以及两组之间的症状性颅内出血（sICH）和成功再灌注。
直接 EVT 和桥接 IVT 前 EVT 的主要结局（分别为 27.3%和 27.7%）和 90 天 mRS 评分分布相似。此外，两组之间 sICH 和 90 天死亡率的发生率无显著差异（7.3%比 6.0%，调整后的比值比（aOR）0.79，95%可信区间 0.34 至 1.86，P=0.84 用于 sICH；46.8%比 43.7%，aOR 0.86，95%可信区间 0.54 至 1.38，P=0.53 用于死亡率）。
在急性 BAO 患者中，桥接 IVT 前 EVT 与直接 EVT 的治疗效果相似，两组 sICH 和死亡率无差异。
