Why the study?
The effectiveness of IV tPA in patients with large-vessel occlusion receiving endovascular treatment for acute ischemic stroke has been questioned.
Does intravenous tissue plasminogen activator (IV tPA) improve clinical outcomes in patients with acute ischemic stroke, including those with large-vessel occlusion receiving endovascular treatment?
Does intravenous tissue plasminogen activator (IV tPA) improve clinical outcomes in patients with acute ischemic stroke, including those with large-vessel occlusion receiving endovascular treatment?
In a real-world cohort of acute ischemic stroke patients, including those undergoing endovascular treatment, the use of IV tPA was associated with improved clinical outcomes.
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.
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Kim et al. (2025) studied this question.
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