Early Phase Thrombolysis and Functional Outcome for Acute Ischemic Stroke Treated with Endovascular Thrombectomy...

The efficacy of intravenous thrombolysis (IVT) in treating acute ischemic stroke (AIS) has shown a rapid decline with time; however, the impact of this trend on IVT prior to endovascular thrombectomy (EVT) remains uncertain.

This study retrospectively analyzed patients from multicenter trials who received EVT after IVT in the anterior circulation. The endpoints included unfavorable outcomes (defined as a 90-day modified Rankin Scale score of 3-6) and hemorrhagic complications. Patients were stratified into two groups based on onset-to-needle time (ONT), with a 2-hour threshold. ONT was defined as the interval from the first observed stroke symptoms (or the last known well state) to the initiation of IVT. Multivariate logistic regression and propensity score matching (PSM) were used to compare outcomes.

Among the 176 patients following PSM (with a median age of 67.5 years and 60.8% being female), the median ONT was 120 minutes (85 minutes vs 176 minutes in early and late phase group), with 88 patients in each group. Multivariate analysis revealed that late phase IVT (ONT > 2 hours) was significantly associated with unfavorable outcomes (odds ratio [OR] = 2.213; 95% confidence interval [CI] = 1.078-4.646; P = 0.032). No significant differences were observed in mortality and hemorrhagic complications between the groups. Subgroup analysis revealed no significant disparities among the predefined subgroups.

Early phase IVT (ONT ≤ 2 hours) before EVT was linked to reduced unfavorable outcomes for AIS. No significant differences were observed among predefined subgroups.