Thrombolysis-to-recanalization time and clinical outcomes in large-vessel occlusion patients with successful...

The benefit of intravenous thrombolysis (IVT) before endovascular treatment (EVT) in patients with anterior circulation large-vessel occlusion (LVO) remains unclear. This study aimed to determine whether thrombolysis-to-recanalization time (TRT) can affect the benefit of IVT.

From the DETECT2-China registry cohort, patients with anterior circulation LVO who achieved complete reperfusion after IVT and bridging EVT were included. Based on TRT corresponding to the minimum adjusted odds ratio (aOR) associated with favorable functional outcome on the restricted cubic spline (RCS), patients were divided into two groups: TRT ≤ 170 min and TRT > 170 min. The primary efficacy outcome was a favorable functional outcome, defined as mRS 0 to 2 at 90 days. Clinical outcomes were compared in the original cohort and in a cohort matched using inverse probability of treatment weighting (IPTW).

A total of 167 eligible patients were included in the final analysis, comprising 82 in the TRT ≤ 170 min group and 85 in the TRT > 170 min group. In the original cohort, TRT ≤ 170 min group had a higher rate of favorable functional outcome (70.7% vs. 50.6%, aOR = 2.919, 95% CI 1.204-7.416, P = 0.020), excellent functional outcome (59.8% vs. 40%, aOR = 2.856, 95% CI 1.225-6.912, P = 0.017). Similar results were found in the IPTW-matched cohort. Furthermore, The restricted cubic spline analysis revealed a linear association between TRT and favorable functional outcome at 90 days (P for linearity = 0.019).

In patients with acute anterior circulation LVO stroke who received IVT-bridging EVT and achieved complete reperfusion post-procedural angiography, there may be a time-dependent benefit of IVT associated with TRT. Shorter TRT may be associated with better clinical outcomes.