Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South Korea
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...
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Korean Society of Critical Care Medicine
2025-05-01
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| Series: | Acute and Critical Care |
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| Online Access: | http://accjournal.org/upload/pdf/acc-004248.pdf |
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| author | Min Kim 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_facet | Min Kim 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_sort | Min Kim |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-70941c9ac8bd4cee8b03237de1721882 |
| institution | Kabale University |
| issn | 2586-6052 2586-6060 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Korean Society of Critical Care Medicine |
| record_format | Article |
| series | Acute and Critical Care |
| spelling | doaj-art-70941c9ac8bd4cee8b03237de17218822025-08-20T03:30:44ZengKorean Society of Critical Care MedicineAcute and Critical Care2586-60522586-60602025-05-0140228229210.4266/acc.0042481591Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South KoreaMin Kim0Ji Sung Lee1Seong-Joon Lee2So Young Park3Jungyun Seo4Ji Man Hong5Hee-Kwon Park6Jae-Kwan Cha7Jeffrey L. Saver8Jin Soo Lee9 Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea Clinical Research Center, Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea Department of Neurology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea Department of Neurology, Dong-A University Hospital, Dong-A University School of Medicine, Busan, Korea Department of Neurology, David Geffen School of Medicine at UCLA, UCLA Comprehensive Stroke and Vascular Neurology Program, Los Angeles, CA, USA Department of Neurology, Ajou University Hospital, Ajou University School of Medicine, Suwon, KoreaBackground 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.http://accjournal.org/upload/pdf/acc-004248.pdfischemic strokeprognosisstrokethrombectomythrombolytic therapy |
| spellingShingle | Min Kim 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 Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South Korea Acute and Critical Care ischemic stroke prognosis stroke thrombectomy thrombolytic therapy |
| title | Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South Korea |
| title_full | Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South Korea |
| title_fullStr | Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South Korea |
| title_full_unstemmed | Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South Korea |
| title_short | Effectiveness of intravenous thrombolysis in patients with large-vessel occlusion receiving endovascular treatment in South Korea |
| title_sort | effectiveness of intravenous thrombolysis in patients with large vessel occlusion receiving endovascular treatment in south korea |
| topic | ischemic stroke prognosis stroke thrombectomy thrombolytic therapy |
| url | http://accjournal.org/upload/pdf/acc-004248.pdf |
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