Abstract
Background and aims
Reperfusion therapies, including intravenous thrombolysis, mechanical thrombectomy, and combined bridging therapy, have significantly improved outcomes in acute ischemic stroke. However, comparative real-world data from developing countries remain limited. This study aimed to evaluate functional outcomes associated with different reperfusion strategies in an Egyptian tertiary stroke center.
Methods
We conducted a retrospective observational study of 237 consecutive patients with acute ischemic stroke treated at Al-Azhar University Hospitals. The cohort included approximately 140 males and 97 females, aged 32 to 85 years. Patients received intravenous thrombolysis, mechanical thrombectomy, or bridging therapy. Baseline demographics, vascular risk factors, stroke subtype classifications, neuroimaging findings, and treatment time metrics were collected. Stroke severity was assessed using the National Institutes of Health Stroke Scale. Functional outcomes were evaluated using the modified Rankin Scale at discharge and at three months. Complications, including hemorrhagic events and mortality, were documented.
Results
Patients treated with mechanical thrombectomy and bridging therapy demonstrated greater neurological improvement and higher rates of favorable functional outcomes compared with those treated with thrombolysis alone. Bridging therapy achieved the highest proportion of good outcomes, followed by mechanical thrombectomy. Overall mortality was lower among patients who achieved successful reperfusion. Shorter door-to-needle and door-to-puncture times were significantly associated with improved functional outcomes.
Conclusions
In this real-world Egyptian cohort, mechanical thrombectomy and bridging therapy were associated with superior functional outcomes compared with intravenous thrombolysis alone. Bridging therapy yielded the most favorable outcomes without an increase in complications, supporting expanded access to endovascular stroke therapies in developing countries.
Conflict of interest
mohamad monzer: nothing to disclose