A study on the efficacy of combined mechanical thrombectomy and intravenous thrombolysis in acute ischemic stroke
介入取栓联合静脉溶栓治疗急性缺血性脑卒中的效果研究

摘要

目的 评估静脉溶栓（IVT）联合机械取栓（MT）对前循环急性大血管闭塞性缺血性脑卒中（AIS-LVO）患者的血管再通率、早期神经功能改善、90d预后及安全性。方法 选取2023年1月至2025年6月湖北省3个高级卒中中心前瞻性数据库中发病6 h内完成血管内治疗的AIS-LVO患者428例。根据是否接受IVT分为观察组（IVT+MT，n=238）与对照组（MT，n=190）。主要结局为术后24 h有效再通（mTICI≥2b），次要结局包括早期神经功能改善（ΔNIHSS≥4）、90 d良好预后（mRS 0-2）、症状性颅内出血（sICH）及90 d全因死亡。采用多因素Logistic 回归及倾向评分匹配（PSM，1:1，卡钳值 0.02）校正混杂。结果 观察组基线NIHSS更高（17.4±5.0 vs 15.9±4.5，P=0.003），发病至穿刺时间无差异。观察组 24 h再通率显著升高（90.8 % vs 80.5 %，P=0.002），早期神经功能改善率（62.6 % vs 47.9 %，P=0.001）及90 d良好预后率（57.6 % vs 43.2 %，P=0.002）亦优于对照组；sICH（4.6 % vs 4.2 %，P=0.789）与90 d死亡率（7.6 % vs 9.5 %，P=0.421）差异无统计学意义。PSM 后获得152对，结果一致。多因素分析显示，桥接治疗（OR=1.96，95 %CI 1.15-3.34）、ASPECTS≥8（OR=2.20，95 %CI 1.23–3.95）及发病至再通≤300 min（OR=1.91，95 %CI 1.06–3.44）是90 d良好预后的独立保护因素。结论 IVT桥接MT可安全有效地提高AIS-LVO患者血管再通率并改善90 d临床结局，推荐在时间窗内常规实施桥接策略。

Abstract

Objective To evaluate the recanalization rate, early neurological improvement, 90-day prognosis, and safety of intravenous thrombolysis (IVT) combined with mechanical thrombectomy (MT) in patients with acute large vessel occlusion ischemic stroke (AIS-LVO) in the anterior circulation.
Methods A total of 428 patients with AIS-LVO who underwent endovascular treatment within 6 hours of symptom onset were selected from the prospective databases of three advanced stroke centers in Hubei Province between January 2023 and June 2025. Patients were divided into an observation group (IVT+MT, n=238) and a control group (MT, n=190) based on whether they received IVT. Primary outcome: effective reperfusion at 24 hours post-intervention (mTICI ≥2b). Secondary outcomes: early neurological improvement (ΔNIHSS ≥4), favorable 90-day outcome (mRS 0-2), symptomatic intracranial hemorrhage (sICH), and 90-day all-cause mortality. Multivariate logistic regression and propensity score matching (PSM, 1:1, cutoff 0.02) were used to adjust for confounders.
Results The observation group had a higher baseline NIHSS (17.4±5.0 vs 15.9±4.5, P=0.003), with no difference in time from onset to puncture. The observation group demonstrated significantly higher 24-hour recanalization rates (90.8% vs 80.5%, P=0.002), early neurological improvement rates (62.6% vs 47.9%, P=0.001), and 90-day favorable outcome rates (57.6% vs 43.2%, P=0.002) compared to the control group. No statistically significant differences were observed in sICH (4.6% vs 4.2%, P=0.789) or 90-day mortality (7.6% vs 9.5%, P=0.421). Post-PSM analysis yielded 152 matched pairs with consistent results. Multivariate analysis identified bridging therapy (OR=1.96, 95% CI 1.15-3.34), ASPECTS ≥8 (OR=2.20, 95% CI 1.23–3.95), and time-to-reperfusion ≤300 min (OR=1.91, 95% CI 1.06–3.44) were independent protective factors for favorable 90-day outcomes.
Conclusion   IVT bridging MT safely and effectively increases recanalization rates and improves 90-day clinical outcomes in AIS-LVO patients. Routine implementation of bridging strategies within the time window is recommended.