Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South Korea

• Published in: Acute and critical care Vol. 40; no. 2; pp. 282 - 292
• Main Authors: Kim, Min, Lee, Ji Sung, Lee, Seong-Joon, Park, So Young, Seo, Jungyun, Hong, Ji Man, Park, Hee-Kwon, Cha, Jae-Kwan, Saver, Jeffrey L., Lee, Jin Soo
• Format: Journal Article
• Language: English
• Published: Korean Society of Critical Care Medicine 01.05.2025; 대한중환자의학회
• Subjects: ischemic stroke; Original; prognosis; stroke; thrombectomy; thrombolytic therapy; 마취과학
• ISSN: 2586-6052; 2586-6060
• DOI: 10.4266/acc.004248

Background: The effectiveness of intravenous tissue plasminogen activator (IV tPA) in patients with large-vessel occlusion (LVO) receiving endovascular treatment (EVT) for acute ischemic stroke (AIS) has been questioned. We investigated IV tPA effectiveness in real-world AIS patients, including those with intracranial LVO receiving EVT.Methods: We identified patients with AIS who presented to hospital with National Institutes of Health Stroke Scale ≥4 within 8 hours of symptom onset from the institutional stroke registry. The association of IV tPA use with effectiveness and safety outcomes was analyzed in overall enrolled AIS patients; LVO patients; and patients treated with EVT. The effect of IV tPA was assessed using multiple logistic regression.Results: Among the 654 patients meeting study entry criteria, 238 (36.4%) received IV tPA and 416 (63.6%) did not. Multiple logistic regression analysis and shift analysis revealed IV tPA was associated with improved outcomes in overall enrolled AIS population, LVO, and EVT-treated subgroups. Among EVT-treated patients, IV tPA was associated with higher likelihood of ambulatory or better outcome (modified Rankin Scale 0–3) with odds ratio of 1.95 (P=0.03).Conclusions: In this real-world study, IV tPA use was associated with improved outcomes for patients with AIS, including among LVO patients treated and not treated with EVT, in the contemporary mechanical thrombectomy era.