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Publications

Journal Article Ahead of print

PubMed: 42089412 DOI: 10.1161/STROKEAHA.126.055656

Time-Dependent Efficacy of Thrombolysis Before Thrombectomy: Registry of Stroke Care Quality (RES-Q).

Stroke

Authors: Robert Mikulik, Geraldo Maranhao Neto, Rupal Sedani, Sandra Thalerová, Natan M Bornstein, Zuzana Gdovinova, Michael D Hill, Adam Kobayashi, Pablo M Lavados, Sheila O Martins, Sandy Middleton, Evija Miglane, Thang Huy Nguyen, Sung-Il Sohn, Nijasri C Suwanwela, P N Sylaja, Georgios Tsivgoulis

Affiliations

  • St. Anne's University Hospital Brno.
  • St. Anne's University Hospital in Brno.
  • World Stroke Organization, CZECH REPUBLIC.
  • International Clinical Research Center, St. Anne's University Hospital Brno, CZECH REPUBLIC.
  • Shaare Zedek Medical Center.
  • Department of Neurology, Safarik University Kosice, Faculty of Medicine, SLOVAKIA.
  • Department of Clinical Neurosciences & Hotchkiss Brain Institute, Hotchkiss Brain Institute, University of Calgary, CANADA.
  • 2nd Department of Neurology, Institute of Psychiatry and Neurology, POLAND.
  • Neurologia vascular, Servicio de Neurologia, Departamento de Neurología y Psiquiatría, Clinica Alemana de Santiago, Facultad de Medicina Clinica Alemana Universidad del Desarrollo, Universidad de Chile. CHILE.
  • Stroke Unit, Neurology Service, Hospital Moinhos de Vento, Hospital de Clinicas de Porto Alegre, BRAZIL.
  • Nursing Research Institute, Australian Catholic University, AUSTRALIA.
  • Neurology Dept. Pauls Stradins Clinical University Hospital, LATVIA.
  • Cerebrovascular Disease, 115 People's Hospital, VIET NAM.
  • Neurology, Dongsan Hospital, Keimyung University School of Medicine, KOREA, REPUBLIC OF.
  • Neurological Unit, Chulalongkorn University Faculty of Medicine, THAILAND.
  • Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, INDIA.
  • Second Department of Neurology, National and Kapodistrian University of Athens,Medical School, Attikon Hospital, GREECE.

Abstract

Background: Randomized evidence suggests that the association of intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) may be time-dependent. We evaluated whether treatment timing modifies the association of IVT+EVT versus EVT alone with short-term in-hospital outcomes. Methods: We conducted a multinational observational registry cohort study using RES-Q data (2022-2024) from 38 countries. Among 3,132 eligible anterior-circulation large-vessel occlusion patients treated with EVT, 3,009 comprised the analytic cohort (IVT+EVT or EVT alone). Primary outcome was ordinal modified Rankin Scale (mRS) at discharge; secondary outcomes were mRS 0-2 at discharge and in-hospital survival. Time strata were ≤100, >100-150, >150-255, and >255 minutes. Confounding was addressed with stabilized inverse probability of treatment weighting (IPTW; weights truncated at 10) using a propensity score including arrival mode, admission location/department, vascular risk factors (hypertension, diabetes, hyperlipidemia, atrial fibrillation, prior stroke, smoking), imaging type, and baseline NIHSS. For EVT-only patients, onset-to-needle time was predicted only to assign time strata. Results: The mean age was 69.2 years (SD 13.2) and 45.6% were female. Treatment-by-time interaction was significant for ordinal discharge mRS (p=0.002) and mRS 0-2 at discharge (p=0.02). IVT+EVT was associated with better outcomes in the earliest treatment windows: at ≤100 minutes, ordinal mRS odds ratio (OR) 1.99 (95% CI, 1.49-2.63), in-hospital survival OR 1.81 (1.13-2.92), and mRS 0-2 OR 1.76 (1.24-2.51); at >100-150 minutes, ordinal mRS OR 1.58 (1.21-2.06) and mRS 0-2 OR 1.64 (1.16-2.31). Associations were attenuated beyond 150 minutes. Conclusions: In routine practice, early IVT before EVT was most consistently associated with improved discharge outcomes.

MeSH

Registries, Stroke, Cerebrovascular Disorders, Therapeutics, Thrombectomy