To investigate the clinical efficacy and safety of rt-PA intravenous thrombolysis (the thrombolysis group) and rt-PA intravenous thrombolysis combined with mechanical thrombectomy (the bridging therapy group) in anterior circulation strokes due to the large vessel occlusion.

A total of 49 patients with a proximal emergent large-vessel occlusion of the anterior circulation within 24 hours after onset were retrospectively included from the department of neurology in Jiangxi Provincial People's Hospital between November 2015 and July 2019. Among them, 24 cases were in the intravenous thrombolysis group and the other 25 cases in the bridging therapy group. In order to assessment the clinical efficacy and safety, baseline characteristics, the response rate after treatment 24 hours and at discharge, favorable outcome and functional independence at 90 days after discharge, and primary safety endpoint events (symptomatic intracranial hemorrhage, death due to any cause during hospitalization and 90 days after discharge) and secondary safety endpoint events (pulmonary infection, gastrointestinal hemorrhage) were compared between two groups.

Baseline data comparison: the prior hypertension and diabetes were more common in the thrombolysis group than the bridging group (66.67% vs 36.00%; 29.17% vs 4.00%) and the difference was statistically significant separately (χ²=4.608, P=0.032; P=0.023), other baseline characteristics did not differ in the two groups (P＞0.05). Curative effect comparison: the response rate after treatment 24 hours and at discharge (32.00% vs 25.00%; 44.00% vs 25.00%) were not statistically significant in both groups (P＞0.05). However, more patients had the favorable outcome and functional independence at 90 days after discharge in the bridging therapy group than those in the thrombolysis group (28.00% vs 4.17%; 36.00% vs 8.33%), the difference was statistically significant separately (P=0.049; χ²=5.384, P=0.020). Safety comparison: the incidence of abnormal renal function and respiratory failure were significantly lower in bridging therapy group than that in intravenous thrombolysis group (8.00% vs 33.33%; 4.00% vs 25.00%) and the difference was statistically significant separately (P=0.037, P=0.049), whilst there was no statistically difference in the primary and secondary safety and other minor endpoint events between the two groups(P＞0.05).

For patients with acute anterior circulation large artery occlusion who have indications of bridging therapy, the efficacy of bridging therapy may be better than intravenous thrombolysis with rt-PA alone, and there was no difference in safety between the two groups.