Bridging Therapy Versus Intravenous Thrombolysis Alone in Patients With Medium Vessel Occlusion Stroke: A Single-Center Cohort Study.

BACKGROUND: To compare the outcomes of bridging therapy versus intravenous thrombolysis (IVT) alone in patients with medium vessel occlusion (MeVO). METHODS: Consecutive MeVO patients between January 2019 and December 2024 were retrospectively included and classified into IVT alone or bridging therapy groups. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0-1 at 90 days. Secondary outcomes included functional independence (mRS 0-2), symptomatic intracranial hemorrhage (sICH). Inverse probability weighting (IPW) and IPW-adjusted logistic regression were used to balance baseline covariates and assess treatment associations. Per-protocol and as-treated sensitivity analyses were performed to assess the robustness of the primary findings. RESULTS: A total of 248 patients with MeVO treated with IVT were included, of whom 86 received bridging therapy. After IPW adjustment, there was no significant difference in the rate of favorable outcome between the bridging therapy and IVT alone groups (59.3% vs. 62.2%; adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 0.75-1.99). Similarly, bridging therapy was not associated with improved functional independence (73.5% vs. 76.3%; aOR, 1.18; 95% CI, 0.66-2.12) or increased risk of sICH (8.0% vs. 5.9%; aOR, 1.37; 95% CI, 0.50-3.75). Both per-protocol and as-treated sensitivity analyses yielded similar results. CONCLUSIONS: Bridging therapy did not improve overall outcomes compared with IVT alone in MeVO patients.