ArticleFrontiers in neurology
Outcomes after direct thrombectomy versus combined thrombolysis and thrombectomy in acute large artery occlusion stroke with atrial fibrillation.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
Background: The role of intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) remains controversial, particularly for patients with acute large vessel occlusion (LVO) due to atrial fibrillation (AF), who may have a poor response to thrombolysis. Furthermore, robust evidence is lacking regarding the benefits of bridging therapy in patients with AF-related AIS-LVO. Accordingly, this study aimed to assess whether patients with AF benefit from bridging thrombectomy. Methods: We performed a retrospective, observational, single-center study from January 2020 to June 2025. Patients meeting the inclusion criteria for both IVT and EVT were enrolled and dichotomized based on thrombectomy type: the bridging thrombectomy (IVT + EVT) group versus the direct thrombectomy (EVT alone) group. After 1:1 propensity score matching (PSM), the outcome measures, including the proportions of patients with modified Rankin scale (mRS) scores of 0-2 at 90 days, the number of retrieval attempts, successful recanalization, door-to-recanalization time, symptomatic intracranial hemorrhage, and mortality within 90 days, were compared. Finally, an exploratory subgroup analysis was performed, stratifying the cohort by age. Results: A total of 221 patients who underwent EVT were included (125 with bridging IVT and 96 with direct EVT). After PSM, there were no significant differences in 90-day functional independence (mRS 0-2) between the two groups (59.0% versus 50.0%; Conclusion: In this real-world, matched-control study, EVT alone demonstrated comparable efficacy to combined IVT + EVT for AF-related LVO. However, in patients aged ≥85, EVT alone significantly improved functional independence and reduced mortality.
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