Effect of intravenous thrombolysis on arterial and venous profiles in large-vessel occlusion stroke: a retrospective propensity score-matched study

Background The value of intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in acute ischemic stroke due to large-vessel occlusion (AIS-LVO) is debated. This study evaluated the association of IVT with arterial collateral, tissue-level collateral (TLC), and venous outflow (VO) profiles on CT angiography and perfusion imaging in EVT-treated AIS-LVO patients.Materials and methods This case-matched retrospective study included consecutive adult patients diagnosed with AIS-LVO and treated with EVT between January 2018 and December 2022. The primary efficacy outcomes were arterial and venous profiles including arterial collateral defined by the Tan score, TLC defined by hypoperfusion intensity ratio, and VO defined by cortical vein opacification score, assessed on CTA after IVT administration. Multivariable logistic regression analyses were performed on propensity score-matched cohorts, and the analyses were repeated in subsequent 1:1 matched cohorts using two different sensitivity analysis protocols. The primary analysis was performed using ordinal logistic regression with treatment allocation as fixed effect.Results Among 87 IVT-treated and 584 non-IVT patients, IVT was independently associated with better arterial collateral scores (OR 0.57; 95% CI: 0.32–0.96; p = 0.019) and more favorable venous outflow profiles (OR 0.50; 95% CI: 0.28–0.88; p = 0.016). Associations strengthened after incorporating ASPECTS scores (arterial collateral: OR 0.40, p = 0.002; VO: OR 0.31, p < 0.001). Rates of 72-hour intracranial hemorrhage and 90-day functional outcomes were comparable.Conclusion In patients with AIS due to LVO, IVT before EVT was associated with favorable arterial collateral and venous outflow profiles on radiological assessment.