Effect of Time Window on Endovascular Thrombectomy with or without Intravenous Thrombolysis in Acute Ischemic Stroke: Results from DIRECT-MT

作者：Deng, Qiwen; Zhang, Lei; Liu, Yukai; Zhou, Feng; Yuan, Zhenhua; Wang, Xixi; Gao, Jie; Yang, Pengfei; Zhang, Yongwei; Xing, Pengfei; Li, Zifu; Hong, Bo; Han, Hongxing; Shi, Huaizhang^*; Shi, Hongchao^*; Liu, Jianmin

来源：Cerebrovascular Diseases, 2023.

DOI：10.1159/000533231

• Acute ischemic stroke
• Intravenous thrombolysis
• Endovascular thrombectomy
• Time window

Introduction: Whether time window affects the intravenous thrombolysis (IVT) effect before endovascular thrombectomy (EVT) is uncertain. We aimed to investigate the effect of different time windows (0-3 h and >3-4.5 h from stroke onset to randomization) on clinical outcomes of EVT with or without IVT in a subgroup analysis of DIRECT-MT. Methods: The primary outcome was the 90-day modified Rankin Scale (mRS) according to time Logistic regression models were used to analyze the effect of different treatments (EVT with or without IVT) on outcomes within 0-3 h or >3-4.5 h. Results: Among 656 patients who were included in the analysis, 282 (43.0%) were randomized within >3-4.5 h after stroke onset (125 without IVT and 157 with IVT), and 374 (57.0%) were randomized within 0-3 h (202 without IVT and 172 with IVT). We noted no significant difference in the thrombectomy-alone effect between the time window subgroups according to 90-day ordinal mRS (adjusted common odds ratio [acOR] in patients within 0-3 h: 1.06 [95% CI: 0.73-1.52], acOR in patients within >3-4.5 h: 1.19 [95% CI: 0.78-1.82]) and 90-day functional independence. Thrombectomy alone resulted in an increased proportion of patients with 90-day mRS 0-3 treated within >3-4.5 h (62.90 vs. 48.72%) but not within 0-3 h (65.84 vs. 63.95%). However, there was no interaction effect regarding all outcomes after the Bonferroni correction. Conclusions: Our results did not support thrombectomy-alone administration within 3-4.5 h in patients with acute ischemic stroke from large-vessel occlusion in the subgroup analysis of DIRECT-MT.

• 单位
  1; 哈尔滨医科大学; 青岛大学