Academic Journal
The pivotal role of timing of intravenous thrombolysis bridging treatment prior to endovascular thrombectomy
| العنوان: | The pivotal role of timing of intravenous thrombolysis bridging treatment prior to endovascular thrombectomy |
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| المؤلفون: | Molad, Jeremy, Hallevi, Hen, Seyman, Estelle, Ben-Assayag, Einor, Jonas-Kimchi, Tali, Sadeh, Udi, Rotschild, Ofer, Simaan, Naaem, Horev, Anat, Cohen, Jose, Leker, Ronen R., Honig, Asaf |
| المصدر: | Therapeutic Advances in Neurological Disorders ; volume 16 ; ISSN 1756-2864 1756-2864 |
| بيانات النشر: | SAGE Publications |
| سنة النشر: | 2023 |
| الوصف: | Background: The role of intravenous thrombolysis (IVT) as bridging treatment prior to endovascular thrombectomy (EVT) is under debate and better patient selection is needed. Objectives: As the efficacy and safety of IVT diminish with time, we aimed to examine the impact of bridging treatment within different time frames from symptom onset. Design: A retrospective registry study. Methods: Data were extracted from ongoing prospective EVT registries in two large tertiary centers. The current study included IVT-eligible patients with onset to door (OTD) < 4 h. We examined the efficacy and safety of bridging treatment through a comparison of the IVT + EVT group with the direct-EVT group by different time frames. Results: In all, 408 patients (age 71.1 ± 14.6, 50.6% males) were included, among them 195 received IVT + EVT and 213 underwent direct EVT. Both groups had similar characteristics. In the IVT + EVT group only, longer OTD was associated with lower rates of favorable outcome ( p = 0.021) and higher rates of hemorrhagic transformation (HT; p = 0.001). In patients with OTD ⩽ 2 h, IVT + EVT compared to direct EVT had higher rates of TICI 2b-3 (86.2% versus 80.7%, p = 0.038). In patients with OTD > 2 h, IVT + EVT had lower rates of favorable outcome (33.3% versus 56.9%, p = 0.021), worse discharge National Institutes of Health Stroke Scale [7 (2–13) versus 3 (1–8), p = 0.024], and higher rates of HT (34.0% versus 8.5%, p < 0.001). Discussion: In this study, we found OTD times to have a significant effect on the impact of IVT bridging treatment. Our study shows that among patients with OTD < 2 h bridging treatment may be associated with higher rates of successful recanalization. By contrast, in patients with OTD > 2 h, bridging treatment was associated with worse outcomes. Further time-sensitive randomized trials are needed. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1177/17562864231216637 |
| الاتاحة: | https://doi.org/10.1177/17562864231216637 https://journals.sagepub.com/doi/pdf/10.1177/17562864231216637 https://journals.sagepub.com/doi/full-xml/10.1177/17562864231216637 |
| Rights: | https://creativecommons.org/licenses/by-nc/4.0/ |
| رقم الانضمام: | edsbas.A56F599A |
| قاعدة البيانات: | BASE |
| DOI: | 10.1177/17562864231216637 |
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