Efficacy and safety of bridging intravenous thrombolysis prior to endovascular treatment in patients over 80 years old with acute ischemic stroke.

INTRODUCTION

Endovascular treatment (EVT) is an effective treatment for patients with acute ischemic stroke (AIS); however, it remains to be determined if treatment with intravenous thrombolysis (IVT) prior to EVT confers any benefit in octogenarians and older. This study aimed to address if bridging tPA has improved functional outcomes or complications in patients 80 years and older.

METHODS

This multicentre retrospective cohort study included patients 80 years old and above who underwent endovascular therapy for large vessel occlusion acute ischaemic stroke in 10 compressive stroke centres across China and Singapore between 2018 and 2024. Clinical and procedural factors of patients in Singapore and China were compared using multivariate binary logistic regression. The primary outcome measured was 3-month functional independence defined as modified rankin scale (mRS) 0-2. Secondary outcomes included 3-month independent ambulation as defined as mRS 0-3, 3-month mortality rates and achieving successful recanalization. Data on intracranial haemorrhage was also collected.

RESULTS

Bridging IVT was not associated with improvement in 3-month functional independence (24.47% vs. 20.97%; p = 0.505), improvement in 3-month independent ambulation (32.80% vs. 41.49%; p = 0.512), 3-month mortality rates (36.17% vs. 33.33%; p = 0.637) or increased rates of successful recanalisation (89.36% vs. 87.63%; p = 0.672),. Instead, patients who underwent bridging IVT had higher rates of haemorrhage compared to patients who did not undergo bridging IVT even after adjusting for confounding factors (OR = 1.921; 95% CI 1.026-3.596; p = 0.041).

CONCLUSION

The findings of this study suggest that bridging IVT prior to EVT may not improve functional outcomes or mortality rates. However, it appears to be associated with an increase in risk of intracranial haemorrhage.