BACKGROUND AND AIMS Patients with emergent large-vessel occlusion (ELVO) that present earlier than 4 h from onset are usually treated with bridging systemic thrombolysis followed by endovascular thrombectomy (EVT). Whether direct EVT (dEVT) could improve the chances of favorable outcome remains unknown. METHODS Consecutively, prospectively enrolled patients with ELVO presenting within 4 h of onset were entered into a National Acute Stroke Registry of patients undergoing revascularization. Patients treated with bridging were compared to those treated with dEVT. Excellent outcome was defined as having a modified Rankin Scale score ≤1 at 90 days following stroke. RESULTS Out of 392 patients that underwent thrombectomy, 270 (68%) presented within 4 h and were included. Of those, 159 (59%) underwent bridging and 111 (41%) underwent dEVT. Atrial fibrillation and congestive heart failure were more common in the dEVT group (43 vs. 30%, p = 0.04 and 20 vs. 8%, p = 0.009, respectively), but other risk factors, demographics, stroke severity and subtypes as well as baseline vessel patency state and time metrics did not differ. Excellent target vessel recanalization defined as TICI 3 (thrombolysis in cerebral infarction score) was more common in the dEVT group (75 vs. 61%, p = 0.03), but in-hospital mortality, discharge destinations, short- and long-term excellent outcome rates did not differ. On multivariate regression analysis, treatment modality did not significantly modify the chances of excellent outcome at discharge (OR 0.7; 95% CI 0.3-1.5) or at 3 months (OR 0.78 95% CI 0.4-1.4). CONCLUSIONS The chances of attaining excellent functional outcomes are similar in ELVO patients undergoing dEVT or bridging.

中文翻译：

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紧急大血管闭塞患者的直接血栓切除术与桥接。

背景和目的 急性大血管闭塞 (ELVO) 患者在发病后 4 小时内就诊，通常接受桥接全身溶栓治疗，然后进行血管内血栓切除术 (EVT)。直接 EVT (dEVT) 是否可以提高有利结果的机会仍然未知。方法 连续将前瞻性入组的 ELVO 发病 4 小时内出现的患者纳入接受血运重建的国家急性卒中登记处。将接受桥接治疗的患者与接受 dEVT 治疗的患者进行比较。优秀结果定义为卒中后 90 天改良 Rankin 量表评分≤1。结果 在接受血栓切除术的 392 名患者中，270 名（68%）在 4 小时内就诊并被纳入。其中，159 人 (59%) 接受了桥接，111 人 (41%) 接受了 dEVT。房颤和充血性心力衰竭在 dEVT 组中更为常见（分别为 43 对 30%，p = 0.04 和 20 对 8%，p = 0.009），但其他危险因素、人口统计学、卒中严重程度和亚型也更常见因为基线血管通畅状态和时间指标没有差异。在 dEVT 组中，定义为 TICI 3（脑梗死溶栓评分）的出色靶血管再通更为常见（75% vs. 61%，p = 0.03），但住院死亡率、出院目的地、短期和长期良好结果率没有差异。在多变量回归分析中，治疗方式并未显着改变出院时（OR 0.7；95% CI 0.3-1.5）或 3 个月时（OR 0.78 95% CI 0.4-1.4）获得优异结果的机会。