Pop Raoul, Finitsis Stephanos, Lapergue Bertrand, Sykora Marek, Strbian Daniel, Mbroh Joshua, Hui Xinchen, Hennersdorf Florian, Ernemann Ulrike, Poli Sven, Gory Benjamin
Department of Interventional Neuroradiology, Strasbourg University Hospitals, Strasbourg, France.
Institut de Chirurgie Minime Invasive Guidée par l'Image, Strasbourg, France.
Eur Stroke J. 2025 Apr 16:23969873251333652. doi: 10.1177/23969873251333652.
Whether intravenous thrombolysis (IVT) provides additional benefit in eligible patients with acute vertebrobasilar occlusion who undergo endovascular treatment (EVT) remains an open question.
We conducted a pooled analysis using data from two national stroke registries, the ETIS registry in France and GSR-ET registry in Germany. Patients who underwent EVT for vertebral and/or basilar artery occlusions from January 2015 to December 2023 were included. The primary efficacy outcome was a favorable shift toward better functional outcomes on modified Rankin Scale (mRS) scores at 90 days. Safety outcomes included 90-days mortality and symptomatic haemorrhagic transformation (sICH). Comparisons between IVT + EVT and direct EVT groups were made combining inverse propensity score matching, probability of treatment weighting (IPTW) and regression models.
Among 2028 patients treated during the study period, 797 (39.2%) received IVT before EVT, while 1231 (60.7%) had EVT alone. After IPTW matching, we compared 211 patients treated with IVT + EVT to 260 direct EVT patients. Patients in the IVT + EVT group had a favorable shift across the 90-day mRS distribution (common aOR 1.43 per 1-point mRS improvement, 95% CI 1.01-2.04; = 0.046), higher odds of 90-day favorable functional outcome (aOR 1.56, 95% CI 1.00-2.44; = 0.049) and lower odds of 90-day mortality (aOR 0.62, 95% CI 0.39-0.99; = 0.045). IVT was not associated with increased risk of sICH (aOR 1.65, 95% CI 0.62-4.35; = 0.313).
This registry-based study suggests a potential benefit of IVT before EVT in eligible patients with vertebrobasilar occlusions. Randomized clinical trials are necessary to confirm these findings and to validate the benefits of IVT in this clinical context.
对于接受血管内治疗（EVT）的急性椎基底动脉闭塞的合适患者，静脉溶栓（IVT）是否能带来额外益处仍是一个悬而未决的问题。
我们使用来自两个国家卒中登记处的数据进行了汇总分析，这两个登记处分别是法国的ETIS登记处和德国的GSR - ET登记处。纳入了2015年1月至2023年12月期间因椎动脉和/或基底动脉闭塞接受EVT的患者。主要疗效结局是在90天时改良Rankin量表（mRS）评分向更好的功能结局有利转变。安全性结局包括90天死亡率和症状性出血转化（sICH）。采用逆倾向评分匹配、治疗概率加权（IPTW）和回归模型相结合的方法对IVT + EVT组和直接EVT组进行比较。
在研究期间接受治疗的2028例患者中，797例（39.2%）在EVT前接受了IVT，而1231例（60.7%）仅接受了EVT。经过IPTW匹配后，我们将211例接受IVT + EVT治疗的患者与260例直接接受EVT治疗的患者进行了比较。IVT + EVT组患者在90天mRS分布上有有利转变（每1分mRS改善的共同aOR为1.43，95%CI为1.01 - 2.04；P = 0.046），90天获得有利功能结局的几率更高（aOR为1.56，95%CI为1.00 - 2.44；P = 0.049），90天死亡率的几率更低（aOR为0.62，95%CI为0.39 - 0.99；P = 0.045）。IVT与sICH风险增加无关（aOR为1.65，95%CI为0.62 - 4.35；P = 0.313）。
这项基于登记处的研究表明，对于合适的椎基底动脉闭塞患者，在EVT前进行IVT可能有益。需要进行随机临床试验来证实这些发现，并验证IVT在这种临床情况下的益处。
