Direct thrombectomy versus bridging alteplase medicine in anterior circulation stroke following endovascular therapy - a multi-center cohort study

Q: What treatment strategies were compared in the study?

The study compared bridging therapy (intravenous rt-PA before EVT) versus direct EVT without rt-PA for anterior circulation AIS due to LVO.

Q: How many patients and what time window were included?

A total of 724 patients with anterior circulation AIS treated with EVT within 8 hours of symptom onset were analyzed.

Q: Did bridging therapy improve functional outcomes or mortality?

No. Pre-EVT rt-PA did not improve 3-month functional independence or reduce mortality compared with direct EVT.

Q: What happened to the reperfusion advantage after adjustment?

Successful reperfusion was higher in the rt-PA group, but this difference did not remain significant after multivariate adjustment for clinical confounders.

Sep 30, 2026

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Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) and endovascular therapy (EVT) are standard options for acute ischemic stroke due to large vessel occlusion in the anterior circulation. This retrospective multicenter study compared bridging therapy (rt-PA before EVT) with direct EVT in 724 patients treated within 8 hours. Primary endpoints were 3-month functional independence, excellent outcome, and mortality. Pre-EVT rt-PA did not improve functional outcomes or reduce mortality. Reperfusion was higher but lost significance after adjustment; hemorrhage risks were similar.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Objective

Methods

Results

Conclusion

Introduction

Background and rationale

Evidence from prior trials

Zeng et al. European Journal European Journal of Medical Research (2026) 31:39 [https://doi.org/10.1186/s40001-025-03591-3](https://doi.org/10.1186/s40001-025-03591-3 of Medical Research)[ of Medical Research](https://doi.org/10.1186/s40001-025-03591-3 of Medical Research) RESEARCH Open Access Direct thrombectomy versus bridging alteplase medicine in anterior circulation stroke following endovascular therapy: a multi-center cohort study Xuehua Zeng1,2†, Mingzhu Feng3†, Mohammad Mofatteh4, Lue Chen5, Jian Yi5, Zunbao Xu6,12, Zile Yan3, Jicai Ma7, Sijie Zhou8, Haiping Wang1, Xiaofeng Lin1, Yuzheng Lai9, Wenhong Peng10*†, Minhua Zhou11*† and Shuiquan Yang3*† Abstract Objective Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) and endovascular therapy (EVT) are established treatments for acute ischemic stroke (AIS) due to large vessel occlusion (LVO) in the anterior circulation. This study aimed to compare the safety and efficacy of bridging therapy (rt-PA before EVT) versus direct EVT in a real-world, multicenter setting. Methods In this retrospective multicenter cohort study, 724 patients with anterior circulation AIS treated with EVT within 8 h of symptom onset were analyzed. Patients received either pre-EVT rt-PA (n = 314) or direct EVT without rt-PA (n = 410) . Primary outcomes included 3-month functional independence (modified Rankin Scale (mRS) 0–2), excellent outcome (mRS 0–1), and mortality. Secondary outcomes included hemorrhagic transformation, parenchymal hematoma, and successful reperfusion (mTICI ≥ 2b) . Multivariate logistic regression was adjusted for key clinical confounders. Results Baseline characteristics were comparable, except for higher median NIHSS scores in the direct EVT group (16 vs. 15, p < 0. 001) . No significant differences were observed in 3-month functional independence (43 . 0% vs. 50. 3%, p = 0 . 051), excellent outcome (36 . 8% vs. 42. 0%, p = 0 . 155), or mortality (22 . 9% vs. 20. 1%, p = 0 . 354) . Hemorrhagic transformation and parenchymal hematoma rates were similar. Although successful reperfusion was higher in the rt-PA group (93 . 6% vs. 88. 5%, p = 0 . 019), this did not remain significant after adjustment. | †Xuehua Zeng and Mingzhu Feng have contributed equally in this study. | | --- | | †Wenhong Peng, Minhua Zhou and Shuiquan Yang have contributed equally as senior authors. | *Correspondence: Wenhong Peng [plate20072007@163.com](plate20072007@163.com)[ ](plate20072007@163.com)Minhua Zhou [zhouminhua7964@163.com](zhouminhua7964@163.com)[ ](zhouminhua7964@163.com)Shuiquan Yang [yangshuiquan1969@126.com](yangshuiquan1969@126.com) Full list of author information is available at the end of the article © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/.)[.](http://creativecommons.org/licenses/by-nc-nd/4.0/.) Zeng et al. European Journal of Medical Research (2026) 31:39 Page 2 of 9 Conclusion Pre-EVT rt

FAQs

What treatment strategies were compared in the study?

The study compared bridging therapy (intravenous rt-PA before EVT) versus direct EVT without rt-PA for anterior circulation AIS due to LVO.

How many patients and what time window were included?

A total of 724 patients with anterior circulation AIS treated with EVT within 8 hours of symptom onset were analyzed.

Did bridging therapy improve functional outcomes or mortality?

No. Pre-EVT rt-PA did not improve 3-month functional independence or reduce mortality compared with direct EVT.

What happened to the reperfusion advantage after adjustment?

Successful reperfusion was higher in the rt-PA group, but this difference did not remain significant after multivariate adjustment for clinical confounders.

Sep 30, 2026

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