Impact of low-dose alteplase bridging therapy on outcomes after mechanical thrombectomy in patients with atrial fibrillation-associated acute stroke: A retrospective cohort study.

Low-dose alteplase bridging therapy achieved higher successful reperfusion rates compared to direct thrombectomy.

• Successful reperfusion (mTICI 2b-3) was 91.7% in the low-dose bridging group (group A, n=120) versus 84.6% in the direct thrombectomy group (group C, n=130).
• Standard-dose bridging group (group B, n=125) received alteplase 0.9 mg/kg plus thrombectomy.
• Study was a single-center retrospective cohort of 375 consecutive eligible patients treated between January 2021 and December 2024.
• Multivariable logistic regression adjusted for age, severity, time metrics, occlusion site, and comorbidities.

Low-dose alteplase bridging therapy was associated with higher rates of 90-day functional independence compared to direct thrombectomy.

• 90-day functional independence (mRS 0-2) was 58.3% in the low-dose bridging group versus 45.4% in the direct thrombectomy group.
• In adjusted models, low-dose bridging predicted 90-day independence with an odds ratio of 1.68.
• Baseline features were reported as similar across the three groups.

Symptomatic intracerebral hemorrhage rates were lower with low-dose alteplase bridging compared to standard-dose bridging and comparable to direct thrombectomy.

• Symptomatic intracerebral hemorrhage occurred in 3.3% of the low-dose bridging group versus 6.4% in the standard-dose bridging group.
• Symptomatic intracerebral hemorrhage in the low-dose group was described as comparable to the direct thrombectomy group.
• In adjusted models, low-dose bridging was associated with lower odds of symptomatic hemorrhage than standard-dose bridging, with an odds ratio of 0.48.

Early neurological improvement and 72-hour NIHSS scores favored low-dose alteplase bridging over comparator groups.

• Early neurologic change and 72-hour National Institutes of Health Stroke Scale scores were reported as favoring the low-dose bridging group.
• These were listed as secondary outcomes alongside mortality and key procedural metrics.
• Specific numerical values for early neurological change and 72-hour NIHSS were not provided in the abstract.

Low-dose alteplase bridging therapy shortened puncture-to-reperfusion time compared to other treatment approaches.

• Low-dose bridging was reported to shorten puncture-to-reperfusion time, a key procedural metric.
• This finding was noted among the secondary outcomes evaluated in the study.
• Specific time values were not reported in the abstract.

The study was a single-center retrospective cohort with no a priori sample size calculation, representing a methodological limitation.

• The study included 375 consecutive eligible patients treated between January 2021 and December 2024.
• No a priori sample size calculation was performed.
• The three groups comprised 120 (low-dose bridging), 125 (standard-dose bridging), and 130 (direct thrombectomy) patients.