Intravenous Thrombolysis Before Thrombectomy Improves Functional Outcome After Stroke Independent of Reperfusion Grade

作者：Annahita Sedghi, Daniel Kaiser, Ani Cuberi, Sonja Schreckenbauer, Claudia Wojciechowski, Ingeborg Friehs, Heinz Reichmann, Jessica Barlinn, Kristian Barlinn, Volker Puetz, Timo Siepmann · 发表于：Journal of the American Heart Association · 年份：2024 · DOI：10.1161/jaha.123.031854 · 被引用次数：10 · 研究领域：Acute Ischemic Stroke Management、Venous Thromboembolism Diagnosis and Management、Stroke Rehabilitation and Recovery

Background We studied the association of bridging intravenous thrombolysis (IVT) before thrombectomy for anterior circulation large‐vessel occlusion and functional outcome and scrutinized its dependence on grade of reperfusion and distal thrombus migration. Methods and Results We included consecutive patients with anterior circulation large‐vessel occlusion from our prospective registry of thrombectomy‐eligible patients treated from January 1, 2017 to January 1, 2023 at a tertiary stroke center in Germany in this retrospective cohort study. To evaluate the association of bridging IVT and functional outcome quantified via modified Rankin Scale score at 90 days we used multivariable logistic and lasso regression including interaction terms with grade of reperfusion quantified via modified Thrombolysis in Cerebral Infarction (mTICI) scale and distal thrombus migration adjusted for demographic and cardiovascular risk profiles, clinical and imaging stroke characteristics, onset‐to‐recanalization time and distal thrombus migration. We performed sensitivity analysis using propensity score matching. In our study population of 1000 thrombectomy‐eligible patients (513 women; median age, 77 years [interquartile range, 67–84]), IVT emerged as a predictor of favorable functional outcome (modified Rankin Scale score, 0–2) independent of modified mTICI score (adjusted odds ratio, 0.49 [95% CI, 0.32–0.75]; P =0.001). In those who underwent thrombectomy (n=812), the association of IVT and fav...