Abstract：
BACKGROUND: Based on recent trials regarding the early time window, omitting intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in eligible patients seems unjustified. Whether this also concerns the extended time window, 4.5 to 9 h from last seen well, is yet unclear.
METHODS: All consecutive patients treated with IVT, EVT, or IVT plus EVT in the extended time window at Helsinki University Hospital (HUS) between 1/2021 and 12/2022 were compared with matched controls treated in the early time window between 1/2016 and 12/2020. Regression analysis was applied on functional outcome at 90 days, evaluated on modified Rankin Scale (mRS), and on the occurrence of symptomatic intracerebral hemorrhage (sICH), adjusted for potential confounders.
RESULTS: Altogether 134 patients and 134 matching controls were included. Functional outcomes did not significantly differ between the extended versus early time window. Among patients with IVT plus EVT, the adjusted odds ratio (aOR) for a favorable outcome shift on mRS was 1.15, 95% confidence interval (CI) 0.54-2.43. Although sICH occurred more frequently (2.2% versus 3.0%) in the extended time window, regression analysis did not show a significant difference, aOR 0.96, 95% CI 0.14-6.87.
CONCLUSIONS: We found no significant differences in the functional or safety outcomes between the extended versus early time window among patients with either IVT, EVT, or IVT plus EVT. There were no signals indicating, that IVT or EVT should be avoided in eligible patients in the extended time window which aligns with the current clinical treatment guidelines of HUS.
METHODS: All consecutive patients treated with IVT, EVT, or IVT plus EVT in the extended time window at Helsinki University Hospital (HUS) between 1/2021 and 12/2022 were compared with matched controls treated in the early time window between 1/2016 and 12/2020. Regression analysis was applied on functional outcome at 90 days, evaluated on modified Rankin Scale (mRS), and on the occurrence of symptomatic intracerebral hemorrhage (sICH), adjusted for potential confounders.
RESULTS: Altogether 134 patients and 134 matching controls were included. Functional outcomes did not significantly differ between the extended versus early time window. Among patients with IVT plus EVT, the adjusted odds ratio (aOR) for a favorable outcome shift on mRS was 1.15, 95% confidence interval (CI) 0.54-2.43. Although sICH occurred more frequently (2.2% versus 3.0%) in the extended time window, regression analysis did not show a significant difference, aOR 0.96, 95% CI 0.14-6.87.
CONCLUSIONS: We found no significant differences in the functional or safety outcomes between the extended versus early time window among patients with either IVT, EVT, or IVT plus EVT. There were no signals indicating, that IVT or EVT should be avoided in eligible patients in the extended time window which aligns with the current clinical treatment guidelines of HUS.
摘要：
背景：根据最近关于早期时间窗口的试验，在符合条件的患者中，在血管内血栓切除术（EVT）之前省略静脉溶栓（IVT）似乎是不合理的。这是否也涉及到延长的时间窗口，从上次看井的4.5到9小时，还不清楚。
方法：所有连续接受IVT治疗的患者，EVT,在2021年1月12日至2022年1月12日期间,在赫尔辛基大学医院(HUS)的延长时间窗内,或IVT加EVT与在2016年1月12日至2020年早期时间窗内治疗的匹配对照进行比较.对90天的功能结局进行回归分析，根据改良的Rankin量表(MRS)进行评估，以及症状性脑出血（sICH）的发生，针对潜在的混杂因素进行了调整。
结果：共纳入134名患者和134名匹配的对照。延长时间窗口与早期时间窗口之间的功能结果没有显着差异。在IVT加EVT的患者中，mRS有利结局变化的校正比值比(aOR)为1.15,95%置信区间(CI)0.54~2.43.尽管sICH在延长的时间窗口中发生的频率更高(2.2%对3.0%)，回归分析没有显示出显著差异，OR0.96,95%CI0.14-6.87。
结论：我们发现延长时间窗与早期时间窗两种IVT患者的功能或安全性结局无显著差异，EVT,或IVT加EVT。没有信号表明，在符合HUS现行临床治疗指南的延长时间窗内,符合条件的患者应避免IVT或EVT.
方法：所有连续接受IVT治疗的患者，EVT,在2021年1月12日至2022年1月12日期间,在赫尔辛基大学医院(HUS)的延长时间窗内,或IVT加EVT与在2016年1月12日至2020年早期时间窗内治疗的匹配对照进行比较.对90天的功能结局进行回归分析，根据改良的Rankin量表(MRS)进行评估，以及症状性脑出血（sICH）的发生，针对潜在的混杂因素进行了调整。
结果：共纳入134名患者和134名匹配的对照。延长时间窗口与早期时间窗口之间的功能结果没有显着差异。在IVT加EVT的患者中，mRS有利结局变化的校正比值比(aOR)为1.15,95%置信区间(CI)0.54~2.43.尽管sICH在延长的时间窗口中发生的频率更高(2.2%对3.0%)，回归分析没有显示出显著差异，OR0.96,95%CI0.14-6.87。
结论：我们发现延长时间窗与早期时间窗两种IVT患者的功能或安全性结局无显著差异，EVT,或IVT加EVT。没有信号表明，在符合HUS现行临床治疗指南的延长时间窗内,符合条件的患者应避免IVT或EVT.
