Safety And Prognosis Of Endovascular Therapy Alone Versus Bridging Therapy In Acute Ischaemic Stroke

Objective: To investigate whether intravenous thrombolysis(IVT)with alteplase(a recombinant tissue plasminogen activator,rt-PA)before endovascular treatment(EVT)is beneficial for acute ischemic stroke(AIS)patients in different periods.Methods: This study enrolled a total of 140 patients hospitalized between 2019 and2022 with AIS from large vessel occlusion(LVO)in the anterior circulation.Those patients were split into the EVT alone group and IVT+EVT group,in which EVT was preceded by intravenous rt-PA.According to the time from onset to femoral artery puncture,the above two groups were divided into the following subgroups: <4.5 h,between 4.5 and 6 h,between 6 and 8 h,and between 8 and 10 h.There were 78 patients in the EVT alone group and 62 patients in the IVT+EVT group.Results: There was no statistically significant difference in functional independence,recanalization rate,favorable outcome rate,or mortality between the EVT and IVT+EVT groups(P > 0.05).After adjusting for confounding factors,the incidence of cerebral hemorrhage was lower in the our EVT group(P < 0.05).A comparison of time-dependent efficacy between the two groups showed that within 6–8 h,there were statistically significant differences between admission and postoperation in the National Institutes of Health Stroke Scale scores at 24 h(P = 0.01)or 7 days(P = 0.02).Conclusions: Although there was no difference in clinical efficacy and safety between the abovementioned two groups,compared to EVT treatment,IVT+EVT could increase the risk of bleeding.Moreover,in the 6–8 h subgroup,the efficacy of EVT alone was better than that of IVT+EVT.