BRIDGING THROMBOLYSIS BEFORE ENDOVASCULAR THERAPY IMPROVES FUNCTIONAL OUTCOMES IN MEDIUM-LARGE CORE STROKE WITHIN 4.5 HOURS: A MULTICENTER PROPENSITY-MATCHED STUDY.
| Title: | BRIDGING THROMBOLYSIS BEFORE ENDOVASCULAR THERAPY IMPROVES FUNCTIONAL OUTCOMES IN MEDIUM-LARGE CORE STROKE WITHIN 4.5 HOURS: A MULTICENTER PROPENSITY-MATCHED STUDY. |
|---|---|
| Authors: | Nguyen TH; Le TQ; Nguyen TQ; Nguyen KV; Tran HTM; Duong HQ; Le ND; Bach DT; Nguyen LC; Ha DT; Pham BN; Tran VT; Le TVS; Nguyen ATK; Mai TT; Nguyen HTB; Dang HQ; Nguyen TN; Nguyen TB; Truong ALT |
| Source: | Cerebrovascular diseases extra [Cerebrovasc Dis Extra] 2026 Mar 18, pp. 1-18. Date of Electronic Publication: 2026 Mar 18. |
| Publication Model: | Ahead of Print |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Karger Country of Publication: Switzerland NLM ID: 101577885 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1664-5456 (Electronic) Linking ISSN: 16645456 NLM ISO Abbreviation: Cerebrovasc Dis Extra Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Basel : Karger, 2011- |
| Abstract: | Background and Aims: The benefit of intravenous thrombolysis (IVT) before endovascular therapy (EVT) in patients with acute ischemic stroke (AIS) with medium-large infarct core (MLIC) remains uncertain.; Methods: We conducted a retrospective analysis of a prospective multicenter registry in Vietnam (August 2023-September 2024). We included patients with AIS-LVO in the anterior circulation within 4.5 hours of onset, an Alberta Stroke Program Early CT Score (ASPECTS) < 6, and a National Institutes of Health Stroke Scale (NIHSS) ≥ 6 at admission. The primary outcome was functional ambulation (defined as mRS 0-3) at 90 days of follow-up. Secondary outcomes were functional independence (mRS 0-2), mRS shift analysis, and rates of successful reperfusion (modified thrombolysis in cerebral infarction 2b-3). Safety outcomes were defined by symptomatic intracranial hemorrhage (ICH) according to SITS-MOST criteria and 90-day mortality. Outcomes between the bridging therapy and EVT alone groups were compared using propensity score-matched (PSM) analysis.; Results: Of 403 MLIC patients undergoing EVT, 148 presented within 4.5 hours, 59 (39.9%) received bridging IVT. After PSM (n=72), with 36 in each group. The median age, proportion of males, baseline ASPECTS, and NIHSS scores were similar between the two groups. The bridging group achieved higher rates of functional ambulation (75% vs 41.7%, OR 4.2, 95% CI 1.54-11.46). Regarding safety, there was no statistically significant difference in symptomatic intracerebral hemorrhage (8.3% vs 11.1%, p = 1.0) or mortality (8.3% vs 19.4%, p = 0.17), though the confidence intervals were wide.; Conclusions: Our study suggests that bridging therapy in patients with acute medium-large ischemic core within 4.5 hours of onset results in better functional outcomes than EVT alone without increasing the sICH rate. Further studies are required to assess the safety and efficacy of bridging therapy.; (The Author(s). Published by S. Karger AG, Basel.) |
| Entry Date(s): | Date Created: 20260318 Latest Revision: 20260324 |
| Update Code: | 20260326 |
| DOI: | 10.1159/000551531 |
| PMID: | 41849637 |
| Database: | MEDLINE |
Journal Article