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Abstract
Background This study investigates the efficacy and safety of bridging intravenous thrombolysis (IVT) before endovascular therapy (EVT) compared with EVT alone in patients with large infarction core.
Methods We conducted a comprehensive search of PubMed, EMBASE, and the Cochrane Library from January 2015 to June 2024. Included studies involved patients with acute ischemic stroke with an Alberta Stroke Program Early CT Score of ≤5 or an ischemic core volume of ≥50 mL. Studies were required to provide either 90-day modified Rankin Scale (mRS) score, reperfusion, symptomatic intracranial hemorrhage (sICH), or 90-day mortality.
Results Nine observational studies with 2641 patients were analyzed. The IVT+EVT group had a higher rate of 90-day functional independence (mRS 0–2; OR 1.56, 95% CI 1.31 to 1.87; adjusted OR (aOR) 1.43, 95% CI 1.21 to 1.68) and 90-day functional outcome (mRS 0–3; OR 1.34, 95% CI 1.11 to 1.62; aOR 1.18, 95% CI 1.02 to 1.37) compared with EVT alone. There was no significant difference in successful reperfusion (OR 1.01, 95% CI 0.62 to 1.64; aOR 1.07, 95% CI 0.74 to 1.54) and 90-day mortality (OR 0.86, 95% CI 0.73 to 1.02; aOR 0.89, 95% CI 0.77 to 1.04) between the two groups. Moreover, patients who received IVT+EVT had a higher rate of sICH (OR 1.30, 95% CI 1.03 to 1.64; aOR 2.21, 95% CI 1.22 to 4.01).
Conclusions In patients with large infarction core, bridging IVT before EVT is associated with favorable functional outcomes compared with EVT, even though bridging therapy entails a higher risk of sICH. Further trials are needed to confirm these findings.
- Intracranial Thrombosis
- Intervention
- Stroke
- Thrombectomy
- Thrombolysis
Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study. The data that support the findings of this study are available from the corresponding author upon reasonable request.
Data availability statement
Data are available upon reasonable request.
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Data availability statement
Data sharing not applicable as no datasets generated and/or analysed for this study. The data that support the findings of this study are available from the corresponding author upon reasonable request.
Data availability statement
Data are available upon reasonable request.
Footnotes
YG and Y-GX are joint first authors.
Contributors The following authors made substantial contributions as follows. (1) YG and WML: conception and design of the study, acquisition of data, or analysis and interpretation of data. (2) HZZ and CL: drafting the article or revising it critically for important intellectual content. (3) HZZ and YGX: final approval of the version to be submitted. (4) WML is responsible for the overall content as guarantor.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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