Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South Korea
- Author:
Min KIM
1
;
Ji Sung LEE
;
Seong-Joon LEE
;
So Young PARK
;
Jungyun SEO
;
Ji Man HONG
;
Hee-Kwon PARK
;
Jae-Kwan CHA
;
Jeffrey L. SAVER
;
Jin Soo LEE
Author Information
- Publication Type:Original Article
- From: Acute and Critical Care 2025;40(2):282-292
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
