Background: The benefit of administering intravenous thrombolysis (IVT) before endovascular treatment (EVT) for acute ischemic stroke remains debated.
Methods: We combined data from the CRCS-K registry in South Korea and the TREAT-AIS registry in Taiwan, forming a unified binational multicenter stroke registry. This dataset included 9,941 acute ischemic stroke patients who received EVT: 2,106 from Taiwan (01/2019 to 04/2023) and 7,835 from Korea (01/2011 to 04/2023). The database structures and variable definitions of both registries were harmonized and integrated.
Results: Patients in Taiwan were older (71.2 ± 13.3 years vs. 69.8 ± 12.8 years) and had a higher prevalence of vascular risk factors than those in Korea. Atherothrombotic stroke was more common in Taiwan (34.7% vs. 25.6%), and Taiwanese patients had higher NIHSS scores (18 [13–23] vs. 14 [9–18]). However, the proportion of bridging IVT was lower in Taiwan (35.9% vs. 45.2%). The proportion of patients achieving a modified Rankin Scale (mRS) score of 0-2 at 90 days was lower in Taiwan (30.0% vs. 40.8%). In an age-sex-NIHSS-subtype matched case-control dataset within 6 hours of onset, the proportion of patients with mRS 0-2 was 43% in the IVT group compared to 32% in the no IVT group (P<0.01). Multivariable models indicated that bridging IVT was significantly associated with mRS 0-2 (adjusted OR, 1.31; 95% CI, 1.08–1.60) and reduced mortality (adjusted OR, 0.65; 95% CI, 0.54–0.80).
Conclusion: Our study indicates that IVT before EVT may provide additional benefits for acute ischemic stroke patients in East Asia.