Liu Hao-Te, Deng Wen-Chun, Chang Ching-Wen, Wu Yi Ming, Wong Ho-Fai, Chang Chien-Hung, Yeap Mun-Chun, Chen Ching-Chang, Chen Chung-Ting, Huang Yu-Ting, Chen Yao-Liang
Department of Diagnostic Radiology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Neuroradiol J. 2025 Feb;38(1):87-92. doi: 10.1177/19714009241269447. Epub 2024 Aug 26.
Differences of treatment outcome between full or reduced dose of tissue plasminogen activator (tPA) for bridge mechanical thrombectomy (MT) in the extended time window have not been clearly established. We aimed to present real-world results of bridge MT with different tPA dosages in the standard and extended windows.
Patients with anterior circulation stroke treated with MT between 2017 and 2021 at two stroke referral centers were retrospectively reviewed. Bridge MT with tPA were categorized as full (0.9 mg/kg) or reduced (<0.9 mg/kg) dose. Standard window (SW) cohort was defined as MT performed within 6 h of acute ischemic stroke onset, while those beyond 6 h as the extended window (EW) cohort. 90 days Modified Rankin Scale (mRS) score, technical treatment success, in-hospital mortality, and post-treatment hemorrhage were analyzed.
A total of 423 patients met the inclusion criteria, 218 of which treated in the SW, while 205 treated in the EW. Within the SW cohort, the full-dose tPA group demonstrated a higher proportion of good functional outcome (GFO) at 90 days (mRS0-3) versus reduced (49% vs 21%, = 0.0358). The overall GFO of SW was higher than that of the EW cohort (33% vs 20%, = 0.0480). Within the EW cohort, GFO was similar between full and reduced dose groups. Successful reperfusion rate was lower in SW versus EW cohorts (39% vs 58%, = 0.0199).
In real-world practice, the GFO of bridge MT is better than MT alone. The tPA dosage is not a determining factor of GFO in EW MT.
在延长时间窗内，用于桥接机械取栓（MT）的全剂量或减量组织纤溶酶原激活剂（tPA）治疗结果的差异尚未明确。我们旨在呈现标准时间窗和延长时间窗内不同tPA剂量桥接MT的真实世界结果。
回顾性分析2017年至2021年在两个卒中转诊中心接受MT治疗的前循环卒中患者。使用tPA的桥接MT分为全剂量（0.9mg/kg）或减量（<0.9mg/kg）组。标准时间窗（SW）队列定义为在急性缺血性卒中发病6小时内进行的MT，而超过6小时的则为延长时间窗（EW）队列。分析90天改良Rankin量表（mRS）评分、技术治疗成功率、住院死亡率和治疗后出血情况。
共有423例患者符合纳入标准，其中218例在SW组接受治疗，205例在EW组接受治疗。在SW队列中，全剂量tPA组在90天时显示出更高比例的良好功能结局（GFO，mRS 0 - 3），与减量组相比（49%对21%，P = 0.0358）。SW组的总体GFO高于EW队列（33%对20%，P = 0.0480）。在EW队列中，全剂量和减量组的GFO相似。SW队列的成功再灌注率低于EW队列（39%对58%，P = 0.0199）。
在实际临床实践中，桥接MT的GFO优于单纯MT。tPA剂量不是EW MT中GFO的决定因素。
