Therapeutic Advances in Neurological Disorders (Dec 2023)

The pivotal role of timing of intravenous thrombolysis bridging treatment prior to endovascular thrombectomy

  • Jeremy Molad,
  • Hen Hallevi,
  • Estelle Seyman,
  • Einor Ben-Assayag,
  • Tali Jonas-Kimchi,
  • Udi Sadeh,
  • Ofer Rotschild,
  • Naaem Simaan,
  • Anat Horev,
  • Jose Cohen,
  • Ronen R. Leker,
  • Asaf Honig

DOI
https://doi.org/10.1177/17562864231216637
Journal volume & issue
Vol. 16

Abstract

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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) 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 2 h, bridging treatment was associated with worse outcomes. Further time-sensitive randomized trials are needed.