Xing Gao-Peng, Li Wei, Cui Chang, Zhao Zi-Ai, Nguyen Thanh N, Chen Hui-Sheng
Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China.
Department of Graduate School, Dalian Medical University, Dalian, China.
CNS Neurosci Ther. 2025 Sep;31(9):e70579. doi: 10.1111/cns.70579.
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.
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.
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.
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.
This trial was registered with ClinicalTrials.gov (NCT04752735).
在接受血管内治疗（EVT）的大血管闭塞（LVO）患者中，桥接静脉溶栓（IVT）的益处存在争议。本研究旨在确定IVT至再通时间（TRT）是否会影响IVT桥接EVT的益处。
基于一项回顾性队列研究，纳入在发病至穿刺时间7小时内接受IVT桥接EVT后成功再通的符合条件的LVO患者，并根据中位TRT分为TRT≤182分钟组和TRT>182分钟组。主要结局是90天时改良Rankin量表（mRS）测量的残疾程度变化。主要安全性结局是症状性颅内出血（sICH）。采用治疗权重的逆倾向（IPTW）进行敏感性分析。
共有83例符合条件的患者纳入最终分析，其中TRT≤182分钟组42例，TRT>182分钟组41例。与TRT>182分钟组相比，TRT≤182分钟组在90天时mRS评分有向较低功能残疾程度转变的趋势（校正OR 1.80，95%CI 0.69-4.75，p=0.19），IPTW分析证实了这一点（OR 1.73，95%CI 1.16-2.59，p=0.06）。TRT≤182分钟组与TRT>182分钟组相比，90天时功能结局优秀的比例在数值上更高（IPTW前分别为56.8%和33.8%；IPTW后分别为58.4%和25.9%）。TRT≤182分钟组与TRT>182分钟组之间sICH无差异。
在接受IVT桥接EVT后成功再通的LVO患者中，IVT的益处可能与TRT有关。这一发现需要在前瞻性试验中得到验证。
本试验已在ClinicalTrials.gov注册（NCT04752735）。
