Background The role of bridging intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in the treatment of acute ischemic stroke (AIS) remains debatable. Atrial fibrillation (AF) associated strokes may be associated with reduced treatment effect from IVT. This study compares the effect of bridging IVT in AF and non-AF patients.
Methods This retrospective cohort study comprised anterior circulation large vessel occlusion (LVO) AIS patients receiving EVT alone or bridging IVT plus EVT within 6 hours of symptom onset. Primary outcome was good functional outcome defined as modified Rankin Scale (mRS) 0–2 at 90 days. Secondary outcomes were successful reperfusion defined as expanded Thrombolysis In Cerebral Infarction (eTICI) grading ≥2b flow, symptomatic intracerebral hemorrhage (sICH), and in-hospital mortality.
Results We included 705 patients (314 AF and 391 non-AF patients). The mean age was 68.6 years and 53.9% were male. The odds of good functional outcomes with bridging IVT was higher in the non-AF (adjusted odds ratio (aOR) 2.28, 95% CI 1.06 to 4.91, P=0.035) compared with the AF subgroups (aOR 1.89, 95% CI 0.89 to 4.01, P=0.097). However, this did not constitute a significant effect modification by the presence of AF on bridging IVT (interaction aOR 0.12, 95% CI −1.94 to 2.18, P=0.455). The rate of successful reperfusion, sICH, and mortality were similar between bridging IVT and EVT for both AF and non-AF patients.
Conclusion The presence of AF did not modify the treatment effect of bridging IVT. Further individual patient data meta-analysis of randomized trials may shed light on the comparative efficacy of bridging IVT in AF versus non-AF LVO strokes.
Data availability statement
Data are available upon reasonable request.
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JHL and ASL are joint first authors.
BYT and LLY are joint senior authors.
Contributors JHL, ASL: methodology, investigation, acquisition of data, data analysis, software, writing – original draft, writing – review and editing, visualization, approval of manuscript. MJ, CS, BPC, RCS, HLT, LM, JF, PP, AK, AM, VM, FY, DS, JSG, GC, PB, OS, CN, AJ, TL, JW, YC, SY, VKS: writing – review and editing, approval of manuscript. BYQT, LLY: conceptualization, methodology, writing – review and editing, approval of manuscript, guarantor of the study.
Funding RCS: funding from National Medical Research Council (NMRC), Singapore. BYT: funding from ExxonMobil-NUS Research Fellowship for Clinicians, Ministry of Health Healthcare Research Scholarship - Master of Clinical Investigation (MCI) Program, National Medical Research Council (NMRC), Singapore. LLY: funding from National Medical Research Council (NMRC), Singapore.
Competing interests RCS: honoraria from Pfizer, AstraZeneca, Schwabe. LM: compensation as a speaker for Balt Prime. JF: editorial board of Journal of NeuroInterventional Surgery, ESMINT president; consulting agreements with Cerenovus, Medtronic, Phenox, Penumbra, Roche, Tonbridge; advisory boards of Stryker, Phenox. GC: honoraria and personal payment from Penumbra. PB: consulting agreements with Perflow Medical, Brainomix, Balt, Stryker, Phenox, Neurovasc; honoraria from Perflow Medical, Brainomix, Stryker, Cerenovus. LLY: vice president of Singapore Neurointerventional Society.
Provenance and peer review Not commissioned; externally peer reviewed.
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