Front Neurol. 2026 Mar 13;17:1780191. doi: 10.3389/fneur.2026.1780191. eCollection 2026.
ABSTRACT
BACKGROUND: The role of intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) remains controversial, particularly for patients with acute large vessel occlusion (LVO) due to atrial fibrillation (AF), who may have a poor response to thrombolysis. Furthermore, robust evidence is lacking regarding the benefits of bridging therapy in patients with AF-related AIS-LVO. Accordingly, this study aimed to assess whether patients with AF benefit from bridging thrombectomy.
METHODS: We performed a retrospective, observational, single-center study from January 2020 to June 2025. Patients meeting the inclusion criteria for both IVT and EVT were enrolled and dichotomized based on thrombectomy type: the bridging thrombectomy (IVT + EVT) group versus the direct thrombectomy (EVT alone) group. After 1:1 propensity score matching (PSM), the outcome measures, including the proportions of patients with modified Rankin scale (mRS) scores of 0-2 at 90 days, the number of retrieval attempts, successful recanalization, door-to-recanalization time, symptomatic intracranial hemorrhage, and mortality within 90 days, were compared. Finally, an exploratory subgroup analysis was performed, stratifying the cohort by age.
RESULTS: A total of 221 patients who underwent EVT were included (125 with bridging IVT and 96 with direct EVT). After PSM, there were no significant differences in 90-day functional independence (mRS 0-2) between the two groups (59.0% versus 50.0%; p = 0.158). Furthermore, direct EVT was associated with a shorter median door-to-recanalization time (125.5 versus 135.5 min; p = 0.015) and fewer median thrombectomy passes (1 versus 2, p = 0.003). The rates of successful recanalization, symptomatic intracranial hemorrhage, and 90-day mortality were comparable. A significant interaction effect between age and treatment modality was observed for the primary outcome of a 90-day mRS score of 0-2 (p for interaction = 0.048). Among patients aged ≥85 years, those receiving EVT alone had a significantly higher rate of functional independence than those in the combined IVT and EVT groups (50.0% versus 12.5%, p = 0.041).
CONCLUSION: In this real-world, matched-control study, EVT alone demonstrated comparable efficacy to combined IVT + EVT for AF-related LVO. However, in patients aged ≥85, EVT alone significantly improved functional independence and reduced mortality.
PMID:41908267 | PMC:PMC13021434 | DOI:10.3389/fneur.2026.1780191