Impact of reperfusion strategies on clinical outcomes in acute ischemic stroke managed under the standardized “BEST Protocol”: a single-center retrospective cohort study
- Author:
Sang Hyun JOO
1
;
Sun Pyo KIM
Author Information
1. Department of Emergency Medicine, Chosun University College of Medicine, Gwangju, Korea
- Publication Type:Original Article
- From:Journal of the Korean Society of Emergency Medicine
2026;37(1):39-46
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Objective:This study evaluated the clinical outcomes of patients with acute ischemic stroke (AIS) based on different reperfusion strategies-intravenous thrombolysis (IVT) alone, mechanical thrombectomy (MT) alone, combined IVT+MT, or non-reperfusion therapy (non-RT)-managed under a standardized “Brain Salvage through Emergent Stroke Therapy (BEST) Protocol” in a single emergency center.
Methods:This study conducted a single-center, retrospective cohort study of 261 AIS patients diagnosed under the BEST Protocol between March 2022 and February 2023. The patients were classified into four groups: IVT alone (n=38), MT alone (n=34), IVT+MT (n=30), and non-RT (n=159). The primary outcome was a favorable functional outcome (modified Rankin Scale≤2) at 90 days. Multivariable logistic regression was performed to determine the independent association of treatment strategies, adjusting for age, initial National Institutes of Health Stroke Scale score, and atrial fibrillation (AF).
Results:The baseline characteristics showed significant differences in initial NIHSS, large vessel occlusion (LVO), and AF (P<0.001). After excluding LVO from the final model for parsimony, multivariable analysis revealed that, compared to the non-RT group, the MT alone group (adjusted odds ratio [aOR], 3.58; 95% confidence interval [CI], 1.23-10.42; P=0.019) and the IVT+MT group (aOR, 5.75; 95% CI, 1.75-18.92; P=0.004) were strongly associated with a favorable 90-day outcome after adjusting for covariates.
Conclusion:In a standardized system like the BEST Protocol, MT-based strategies (MT alone or IVT+MT) were independently associated with a significantly higher likelihood of favorable 90-day functional outcomes compared to non-RT.
