Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

While the current results do not necessarily support the dismissal of intravenous tPA in BT, they open up the opportunity for greater individualisation in the decisionmaking for patient who had LVOS presenting directly to thrombectomy-capable centres that can promptly perform endovascular treatment.5 In this context, BT may still be advantageous in a large proportion of patients but it might be reasonable to withhold tPA in certain situations such as those occlusions associated with very high clot burden (such as internal carotid artery occlusions), those with large baseline infarcts who may be at higher risk for intracerebral haemorrhage and those requiring stenting due to the need for dual antiplatelet agents. In addition, forgoing intravenous tPA reduces cost, which in many medical systems represents an important part of the decision-making process. Finally, it is critical to acknowledge the potential advantages of tenecteplase over tPA including easier and faster administration as well as higher rates of recanalisation in patients who had LVOS who are subsequently treated with thrombectomy.8 Therefore, in the future, additional exploration of BT remains valuable, especially with tenecteplase

we provide an aggregate data metaanalysis of the DIRECT-MT,1 the DEVT2 and the SKIP3 trials. The OR for 90-day functional independence (90-day mRS 0–2) was 1.08 (95% CI 0.85 to 1.38) while the OR for any 1-point improvement across the disability scale (ordinal shift 90-day mRS) was 1.06 (95% CI 0.86 to 1.31). The percentage of achieving a Thrombolysis in Cerebral Infarction score 2b–3 was numerically higher in the bridging group, around 5% in DIRECT-MT1 and 3% in SKIP.3 The rates of successful recanalisation, 90-day mortality, and symptomatic intracerebral haemorrhage were not significantly different between the dEVT and the BT groups