急性后循环大血管闭塞桥接治疗与直接取栓结局及相关因素研究：一项多中心前瞻性队列研究

目的 比较发病4.5 h内的急性后循环大血管闭塞患者静脉溶栓（intravenous thrombolysis，IVT）联合
血管内治疗（endovascular treatment，EVT）与直接取栓治疗的疗效差异。
方法 本研究为多中心前瞻性队列研究，连续纳入2018年7月-2019年5月全国18家分中心发病4.5 h
内的急性后循环大血管闭塞患者。根据实际治疗方式，分为桥接治疗组（IVT+EVT）和直接取栓组
（direct endovascular treatment，D-EVT）。主要结局为发病90 d的神经功能预后，良好预后定义为mRS评
分0～2分，采用多因素Logi sti c回归分析评估两组90 d预后的差异。
结果 研究纳入123例患者，平均年龄62.79±11.07岁，男性85例（69.11%），其中D -EVT组98例
（79.67%），IVT+EVT组25例（20.33%）。与IVT+EVT组相比，D-EVT组取栓≥3次病例更多（26.52%
vs 8.00%，P =0.04）；多因素分析显示，IVT+EVT组良好预后比例高于D -EVT组（aOR 0.2，95%CI
0.06～0.71，P =0.01）。
结论 对于发病4.5 h内的急性后循环大血管闭塞患者，静脉溶栓联合血管内治疗较单纯血管内治
疗90 d神经功能预后更佳。     

后循环急性缺血性卒中血管内治疗与静脉溶栓的对照研究

目的 比较后循环大血管闭塞致急性缺血性卒中患者接受血管内治疗（endovascular treatment，EVT） 与单纯静脉溶栓（intravenous thrombolysis，IVT）治疗后的临床结局。 方法 纳入2012年3月-2016年11月期间在北京天坛医院行EVT与IVT治疗的后循环大血管闭塞所致 急性缺血性卒中患者，以1∶1比例匹配两组的年龄、性别、基线NIHSS评分、发病至治疗时间及卒中亚型 （TOAST分型），匹配患者的NIHSS评分≥10分。主要疗效结局为治疗后90 d的mRS评分，安全性结局为 24 h ICH及90 d全因死亡率。 结果 共纳入328例后循环急性缺血性卒中患者，其中EVT组69例，IVT组259例，匹配后两组基线数 据相似，每组各55例。各卒中亚型比例在两组均有显著性差异（所有P <0.001），两组均以大动脉粥 样硬化型为主，其中EVT组63例（91.3%），IVT组164例（63.3%）。临床疗效结局显示匹配后EVT组90 d mRS评分≤1分比例（30.9% vs 38.2%，校正OR 0.724，95%CI 0.329～1.595，P =0.423）及mRS评分≤2 分比例（38.2% vs 50.9%，校正OR 0.596，95%CI 0.279～1.272，P =0.181）均低于IVT组，但差异均无统 计学意义。安全性结局方面，24 h症状性脑出血及治疗后90 d全因死亡率，两组比较差异也无统计学 意义。 结论 对于后循环大血管闭塞所致急性缺血性卒中患者行EVT治疗和单纯IVT治疗，在疗效及安全 性结局方面均无显著性差异。     

急性前循环大血管闭塞缺血性脑卒中直接机械取栓的疗效分析

目的 探讨急性前循环大血管闭塞(aLVO)性脑卒中直接机械取栓治疗的临床疗效及安全性.方法 59例发病时间在4.5h内的前循环大血管急性闭塞患者,随机分至直接取栓组(29例)和静脉溶栓联合机械取栓组(桥接治疗组,30例).分析比较两种治疗方法患者治疗后血管开通、术后90 d神经功能预后良好(改良Rankin量表评分0～...     

直接取栓术治疗急性前循环大血管闭塞41例

目的 探讨直接机械取栓术治疗急性前循环大血管闭塞的有效性.方法 回顾性分析2016年4月至2018年4月机械取栓术治疗的41例急性前循环大血管闭塞的临床资料.使用改良脑梗死溶栓分级(mTICI)评价血管开通效果.发病90 d采用改良Rankin量表(mRS)评分评估预后,0～2分为预后良好.结果 41例中,血管开通达到...     

急性缺血性脑卒中血管内治疗21例临床分析

目的探讨急性缺血性脑卒中血管内治疗的方法、疗效和安全性。方法回顾性分析血管内治疗的大血管闭塞的急性缺血性脑卒中患者21例。10例为阿替普酶静脉溶栓后桥接血管内治疗,11例直接行血管内治疗。其中机械取栓12例,机械取栓+支架植入3例,单纯颈动脉支架植入3例,机械取栓+动脉溶栓1例,机械取栓+动脉溶栓+支架植入1例,单纯动脉溶栓1例。评估术中mTICI再通等级、并发症及术后随访第90天m RS评分,分析疗效与安全性。结果21例患者前循环卒中18例,后循环卒中3例。NIHSS评分平均15. 81±6. 44分。20例患者术后血管再通达mTICI 2 b-3级。术中并发出血1例,术后大量颅内出血1例,无症状少量颅内出血4例。术后高灌注综合征8例,其中4例行去骨瓣减压术,最终死亡5例(23. 81%)。术后随访第90天mRS评分0～2分8例。结论经充分评估并及时采取适宜的单一或多种血管内治疗方法对于大血管闭塞导致的急性缺血性脑卒中患者安全有效。     

急性基底动脉闭塞血管内介入治疗的疗效及预后不良的危险因素

目的 探讨急性基底动脉闭塞（ABAO）血管内介入治疗（EVT）的疗效及预后不良的危险因素。方法 回顾性分析2012年7月至2015年7月收治的172例ABAO的临床资料。102例先采用重组组织型纤溶酶原激活剂动脉内容栓治疗，其中89例溶栓失败再行Solitaire TM支架取栓术治疗；70例直接采用Solitaire TM支架取栓术治疗。结果 172例EVT后，153例获得满意前向血流，血管再通成功率为88.95%；病死率为11.05%。术后90 d，98例预后良好（改良Rankin量表评分0~2分），74例预后不良（改良Rankin量表评分3~6分）。多因素Logistic回归分析显示术前美国国立卫生研究院卒中量表评分≥20分、术前后循环Alberta卒中项目早期CT评分<7分、美国介入和治疗神经放射学学会/介入放射学学会评分0~1级血流及血管未再通是EVT后预后不良的独立危险因素。结论 EVT治疗ABAO疗效确切，影响预后不良的危险因素很多，应采取针对性措施，以改善病人预后。     

急性后循环大血管闭塞性脑梗死桥接治疗与直接血管内治疗的疗效和安全性对比研究

目的 探讨桥接治疗和直接血管内治疗对急性后循环大血管闭塞性脑梗死患者的安全性和有效性。方法 本研究采用回顾性、多中心研究方法,应用Epidata数据库,收集2020年1月—2021年12月江苏省4家医疗中心急性后循环大血管闭塞性脑梗死患者动脉取栓数据,根据治疗方式分为桥接治疗组（急诊血管内治疗前给予阿替普酶静脉溶栓）和直接血管内治疗组。收集患者一般基线数据和结局指标,比较两组患者基线特征和治疗后预后情况。使用术后90 dmRS评分评估患者预后,0～2分为预后良好,3～6分为预后不良;主要有效性结局指标为90 d mRS评分和90 d血管性死亡率;主要安全性指标为术后48 h内出现症状性颅内出血（symptomatic intracerebral hemorrhage,sICH）、再灌注损伤、造影剂渗漏。采用logistic回归分析影响后循环取栓术预后的独立危险因素。结果 共纳入125例急性后循环大血管闭塞性脑梗死患者,其中接受桥接治疗28例,直接血管内治疗97例。入院时,桥接治疗组丙氨酸转氨酶（alanine aminotransferase,ALT）[13.9(11.3～23.2)U...     

神经介入：回眸2022

<正>2022年,国际上公布了多项大型神经介入领域的随机对照试验（randomized controlled trial,RCT）结果,在血管内治疗（endovascular treatment,EVT）急性大血管闭塞（large vessel occlusion,LVO）适应证的扩展、药物治疗、管理,症状性颅内动脉粥样硬化性狭窄（symptomatic intracranial atherosclerotic stenosis,sICAS）治疗,无症状性颈动脉狭窄治疗,     

支架取栓治疗脑前循环急性大血管闭塞型中重度缺血性脑卒中的疗效分析

目的评价Solitaire支架取栓治疗脑前循环急性大血管闭塞型中重度缺血性脑卒中的疗效及风险。方法纳入2013年1月至2016年9月内蒙包头市中心医院神经内科连续收治的颅内前循环急性大血管闭塞型中重度缺血性脑卒中患者55例,根据治疗方法的不同分为静脉溶栓组(27例)和支架取栓组(28例),比较分析2组患者临床资料差异、治疗前后美国国立卫生研究院神经功能缺损评分(NIHSS)的变化、治疗后24h内症状性颅内出血(sICH)发生率、治疗后30d内死亡率及治疗后90d时改良Rankin量表评分(mRS)差异。结果 2组发病时间(症状出现到准备治疗时间)比较,差异具有统计学意义(P0.05);与治疗前相比,支架取栓组在治疗后即刻、治疗后24h时、治疗后7d时、治疗后2w时NIHSS评分均降低,差异有统计学意义(P0.05);与静脉溶栓组相比,支架取栓组治疗后7d时NIHSS评分降低不明显(P0.05),治疗后2w时NIHSS评分明显降低(P0.05);2组24h内症状性颅内出血发生率及30d内死亡率无明显差异(P0.05);治疗90d时支架取栓组良好预后率明显优于静脉溶栓组。结论 Solitaire支架取栓治疗脑前循环急性大血管闭塞型中重度缺血性脑卒中比静脉溶栓治疗更有效,而治疗风险并未增加。     

支架机械取栓治疗急性基底动脉闭塞的疗效观察

目的观察急性基底动脉闭塞行支架机械取栓治疗的可行性和疗效。方法回顾性纳入2013年9月至2016年12月海军军医大学附属长海医院神经外科收治的30例急性基底动脉闭塞的患者。其中采用Solumbra技术取栓17例,采用单纯支架取栓13例。评价基底动脉闭塞行支架机械取栓治疗的技术可行性、血管再通率、90 d时的预后良好率及手术并发症等。分析术后24 h的神经功能变化、不同技术手段对血管再通率的影响及卒中分型与预后的关系。结果30例急性基底动脉闭塞患者中,50%（15例）的患者为心源性栓塞型。支架机械取栓术后有87%（26/30）的闭塞血管成功再通[改良脑梗死溶栓（mTICI）分级为2b/3级];术后90 d的预后良好率[改良Rankin量表评分（mRS）≤3分]为67%（20/30）。支架取栓术后24 h美国国立卫生研究院卒中量表（NIHSS）评分的中位数较术前明显降低（分别为3分、25分,P＝0.003）。单因素分析结果表明,Solumbra技术组一次取栓血管再通达到mTICI 2b/3级的比率明显高于单纯支架取栓组（分别为69%、30%,P＝0.033）;心源性栓塞型患者的预后良好率明显高于大动脉粥样硬化型患者（分别为87%、45%,P＝0.038）。常见的手术并发症或不良事件包括异位栓塞、出血转化、无效再灌注、再闭塞等。术后90 d随访的病死率为10%（3/30）。结论急性基底动脉闭塞行支架机械取栓治疗安全可行;选择适宜的支架取拴技术有利于提高血管再通率。心源性栓塞型可能是预测基底动脉闭塞机械取栓术后预后良好的重要因素。     

Safety of Mechanical Thrombectomy with Combined Intravenous Thrombolysis in Stroke Treatment 4.5 to 9 Hours from Symptom Onset

BackgroundAn extended time window for intravenous thrombolysis (IVT) for acute stroke patients up to 9 hours from symptom onset has been established in recent trials, excluding patients who received mechanical thrombectomy (MT). We therefore investigated whether combined therapy with IVT and MT (IVT+MT) is safe in patients with ischemic stroke and large vessel occlusion (LVO) in an extended time window.MethodsWe retrospectively analyzed patients with anterior circulation ischemic stroke and LVO who were treated within 4.5 to 9 hours after symptom onset using MT with or without IVT. Primary endpoint was the occurrence of any intracranial hemorrhage (ICH). Multivariable logistic regression was used to adjust for potential confounders.ResultsIn total, 168 patients were included in the study, 44 (26%) were treated with IVT+ MT. 133 (79%) patients had a M1-/distal carotid artery occlusion. Median ASPECT-Score was 8 (IQR 7-10) and complete reperfusion (mTICI 2b-3) was achieved in 132 (79%) patients. 18 (41%) of the patients in the IVT+MT group developed any ICH vs. 45 (36%) patients in the direct MT group (p=0.587). Symptomatic ICH occurred in 5 (11%) patients with IVT+MT vs. 8 (6%) patients receiving direct MT (p=0.295). In multivariable analysis, IVT+MT was not an independent predictor of ICH (adjusted for NIHSS, degree of reperfusion, symptom-onset-to-treatment time and therapy with tirofiban; OR 0.95 [95% CI 0.43-2.08], p=0.896).ConclusionMechanical thrombectomy in stroke patients seems to be safe with combined intravenous thrombolysis within 4.5 to 9 hours after onset as it did not significantly increase the risk for intracranial hemorrhage.     

Endovascular thrombectomy with or without intravenous thrombolysis in acute basilar artery occlusion ischemic stroke: A meta-analysis

IntroductionIt is poorly understood if endovascular thrombectomy (EVT) with or without intravenous thrombolysis (IVT) better facilitates clinical outcomes in patients with acute basilar artery occlusion (BAO) ischemic stroke.MethodsA systematic literature review and meta-analysis was completed to investigate the outcomes of EVT with IVT versus direct EVT alone in acute BAO. Data was collected from the literature and pooled with the authors’ institutional experience. The primary outcome measure was 90-day modified Rankin sale (mRS) of 0-2. Secondary measures were successful post-thrombectomy recanalization defined as mTICI ≥2b, 90-day mortality, and rate of symptomatic ICH.ResultsOur institutional experience combined with three multicenter studies resulted in a total of 1,127 patients included in the meta-analysis. 756 patients underwent EVT alone, while 371 were treated with EVT+IVT. Patients receiving EVT+IVT had a higher odds of achieving a 90-day mRS of ≤ 2 compared to EVT alone (OR: 1.50, 95% CI 1.15 to 1.95, P =0.002, I² =0%). EVT+IVT also had a lower odds of 90-day mortality (OR: 0.57, 95% CI 0.37 to 0.89, P=0.01, I²=24%). There was no difference in sICH between the two groups (OR: 1.0, 95% CI: 0.56 to 1.79, P=0.99, I²=0%). There was also no difference in post-thrombectomy recanalization rates defined as mTICI ≥2b (OR: 1.11, 95% CI 0.70 to 1.75, P = 0.65, I²=37%).ConclusionsOn meta-analysis, EVT with bridging IVT results in superior 90-day functional outcomes and lower 90-day mortality without increase in symptomatic ICH. These findings likely deserve further validation in a randomized controlled setting.     

大面积梗死急性缺血性卒中患者血管内治疗的有效性和安全性研究

目的 观察低ASPECTS评分的大面积梗死患者血管内治疗的有效性和安全性,并探讨预后的影响 因素。 方法 从急性缺血性卒中血管内治疗关键技术及急救流程改进研究-前瞻性、多中心、登记研究 （endovascular treatment key technique and emergency work flow improvement of acute ischemic stroke, ANGEL-ACT）中筛选接受血管内治疗,且ASPECTS/后循环ASPECTS（post-circulation ASPECTS,pc- ASPECTS）＜6分的大面积脑梗死患者,分析影响患者预后的因素。有效性终点为术后90 d预后良好 （mRS 0～3分）,安全性终点包括术后24 h内症状性颅内出血（symptomatic intracranial hemorrhage,sICH） 和术后90 d全因死亡。 结果 共纳入121例患者,其中男性89例（73.55%）,中位年龄62.0（54.0～72.0）岁,失访6例,纳 入统计分析的共115例患者。术后90 d预后良好53例（46.09%）,基线低NIHSS（OR 0.908,95%CI 0.841～0.980,P =0.0130）和闭塞血管再通成功（OR 13.676,95%CI 1.396～134.004,P =0.0247）是术 后90 d预后良好的独立预测因子。术后24 h内发生sICH 21例（18.26%）,穿刺至再通时间长（OR 1.009, 95%CI 1.002～1.017,P =0.0163）和病变血管合并串联狭窄（OR 4.202,95%CI 1.457～12.119,P =0.0079） 是术后24 h内sICH的独立预测因子。术后90 d全因死亡23例（20.00%）,基线高NIHSS（OR 1.089, 95%CI 1.014～1.170,P =0.0186）和术后24 h内sICH（OR 4.688,95%CI 1.382～15.898,P =0.0132）是术 后90 d全因死亡的独立预测因子。 结论 大面积梗死的急性缺血性卒中患者接受血管内治疗虽然风险较高,但术前严格地筛选低 NIHSS患者,术中尽量获得闭塞血管再通成功能够使患者获益。     

The Yield of Multimodal Computed Tomography among Emergency Department Patients with Suspected Large Vessel Occlusion Stroke

Objectives: Endovascular therapy (EVT) improves outcomes for appropriately selected acute ischemic stroke patients. Guidelines suggest rapid acquisition of noninvasive vascular imaging to screen suspected ischemic stroke patients for large vessel occlusion (LVO) and candidacy for EVT. We sought to quantify the yield of an LVO stroke screening process in an undifferentiated emergency department (ED) suspected stroke population as well as identify predictors of successful EVT. Methods: We identified a cohort of consecutive ED patients who received CT angiography and brain perfusion (CTA/P) imaging to determine candidacy for EVT during 2016. In keeping with the guidelines at that time, hospital protocol directed physicians to obtain CTA/P studies if time from the onset of symptoms was less than or equal to 6 hours, and the National Institute of Health Stroke Scale (NIHSS) more than or equal to 6 or if recommended by the consulting stroke neurologist. Final discharge diagnoses, EVT attempts, and successful reperfusion (TICI 2b or better) were recorded. Yield of CTA/P was compared among patients based on NIHSS and duration of symptoms. Results: Over a 12-month period, 406 suspected stroke patients were screened with CTA/P; 273 (67%) received a final diagnosis of ischemic stroke. Among cases screened, 53 (13%) underwent attempted EVT; 35 (9%) achieved successful reperfusion. Only 1 of 113 (1%) patients with an NIHSS less than 6 was successfully treated with EVT compared to 34 of 285 (12%) with higher NIHSS (p = 0.001). The probability of successful EVT declined with increasing symptom duration (p = 0.009 for trend). In multivariable analysis, NIHSS more than or equal to 6 was associated with successful EVT (odds ratio [OR] 4.0 [1.6 to 9.9]) but presentation within 6 hours of onset was not (OR 2.3 [0.8 to 6.7]). Conclusions: EVT candidates were common among suspected stroke patients screened with CTA/P in the ED, however, patients with NIHSS less than 6 rarely received successful EVT.     

Effects of tumor type on outcomes in patients with large vessel occlusion stroke and cancer

BackgroundLarge vessel occlusions (LVO) stroke is associated with cancer. Whether this association differs among patients with LVO that undergo endovascular thrombectomy (EVT) according to cancer type remains unknown.Patients and methodsData from consecutive patients that underwent EVT for LVO at three academic centers were pulled and analyzed retrospectively. Patients with LVO and solid tumors were compared to those with hematological tumors. Associations of cancer type with 90-day functional outcome and mortality were calculated in multivariable analyses.ResultsOf the 154 patients with cancer and LVO that underwent EVT (mean age 74±11, 43% men, median NIHSS 15), 137 had solid tumors (89%) and 17 (11%) had hematologic tumors. Patients with solid cancer did not significantly differ from those with hematological malignancy in demographics, risk factor profile, stroke severity and subtype, and procedural variables. Outcome parameters including rates of favorable target recanalization and favorable outcome or mortality at discharge and 90 days post stroke were similar. Safety parameters including rates of symptomatic intracranial hemorrhage also did not differ between the groups. On regression analyses, controlling for various prognostic variables cancer type was not associated with mortality or favorable outcomes.ConclusionsOur study suggests that the safety and efficacy of EVT in patients with malignancy does not depend on cancer type. Patients with malignancy should be considered for EVT regardless of cancer type.     

Changes in blood gas values and electrolytes in the occluded artery predict outcomes after endovascular treatment in ischemic stroke

Background and purposeEndovascular treatment (EVT) is the best treatment for acute ischemic stroke with large vessel occlusion (LVO) and makes it possible to analyze the blood contents from the occluded vascular compartments. In this study, we attempted to evaluate regional changes in blood gas values and electrolytes in the occluded vessels, aiming to determine whether these changes can predict outcomes in LVO patients receiving EVT.Materials and methodsWe prospectively observed 45 consecutive ischemic stroke patients with LVO of the anterior circulation who underwent EVT. We collected the arterial blood proximal to the occlusion site before and after EVT, and the blood within the core of the occluded vascular compartment (distal to the thrombus) and evaluated the labs for blood gas values and electrolytes. Femoral samples were obtained under physiological flow conditions to represent systemic arterial blood.ResultsCompared with the femoral arterial blood samples, significant decreases in K+, Ca2+, HCO3−, BE, HCT, tHbc, and TCO2 levels were observed in the proximal luminal blood before EVT. Decreases in K+ and Ca2+ levels were also observed in the proximal luminal blood after EVT. Proximal/femoral ratio of pH and Na+ was associated with short-term clinical outcomes at 72 hours after EVT. A higher proximal/femoral Na+ ratio was associated with successful recanalization. Further analysis after propensity score matching showed significant changes in blood gas and electrolyte among different arterial locations in ICA and MCA LVO participants. Linear regression analyses indicated that the proximal/femoral ratio of pH, Na+, pCO2, HCO3, and TCO2 before EVT were associated with decrease in NIHSS score at 72 hours in ICA-LVO group.ConclusionsObvious changes in several parameters of arterial blood gas and electrolyte from the ischemic vasculature occur during hyperacute stroke. Proximal/femoral pH and Na+ ratio before EVT may be associated with short-term clinical outcome, which deserve to be further investigated.     

Endovascular Therapy for Acute Ischemic Stroke in Patients with Large-Vessel Occlusion due to Atherosclerotic Stenosis

ObjectivesEndovascular therapy (EVT) is safe and effective for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). However, the influence of the AIS subtype (large-artery atherosclerosis [LAA] or cardioembolism [CE]) on clinical outcome in patients treated with EVT remains unclear. This study aimed to evaluate the differences in clinical results between the two subtypes using data from a multicenter prospective registry (RESCUE-Japan Registry 2).Materials and MethodsAmong 2420 patients in RESCUE-Japan Registry, 682 patients who were diagnosed with LAA or CE were enrolled. The primary outcome was a modified Rankin Scale (mRS) score of 0–2 at 90 days. The secondary outcomes were 90-day mRS 0–1, 0–3, and 6. The relationship between time from onset and clinical outcome was also analyzed.ResultsAmong the 682 patients, 124 were classified into the LAA group and 558 into the CE group. The baseline National Institutes of Health Stroke Scale score was significantly lower (median 15 vs. 18, p < 0.001). At 90 days, mRS 0–2 was observed in 54 of 124 patients (44%) in the LAA group and 232 of 558 patients (42%) in the CE group (p = 0.69). The proportion of patients with mRS 0–2 tended to decrease according to onset-to-puncture time in the CE group but not in the LAA group (p_trend=0.0007).ConclusionsThe rate of good outcome was similar between LVO due to LAA and CE. However, the rate of favorable outcome did not decrease according to onset-to-puncture time in the LAA group.     

Case Fatality Decline from 2009 to 2013 among Medicare Beneficiaries with Ischemic Stroke

ObjectivesThis study aimed to examine the temporal trend of 30-day and 1-year mortality among U.S. Medicare beneficiaries who were hospitalized for ischemic stroke, with special focus on the mortality among subgroup of patients in relation to acute reperfusion therapies including intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT).MethodsWe evaluated Medicare fee-for-service beneficiaries age 65 years or older who were hospitalized for ischemic stroke between 2009 and 2013. Multivariable Cox proportional hazards models were generated to analyze the trend of adjusted mortality.ResultsA total of 1,070,574 patients were included in the study. The 30-day mortality did not change among patients who were not treated with IVT or EVT. It decreased by 13% among patients treated with IVT but not EVT (HR = .87, 95% CI .82-.92), 25% among patients treated with EVT but not IVT (HR = .75, 95% CI .59-.95), and 37% among patients treated with both IVT and EVT (HR = .63, 95% CI .52-.77). One-year mortality decreased by 19% among patients who were not treated with IVT nor EVT (HR = .81, 95% CI .80-.83), 22% among those treated with IVT but not EVT (HR = .78, 95% CI .75-.81), 33% among those treated with EVT but not IVT (HR = .67, 95% CI .55-.81), and 38% among those treated with both IVT and EVT (HR = .62, 95% CI .53-.73).ConclusionsFrom 2009 to 2013, the 30-day stroke case fatality decreased only among the patients received reperfusion therapy. The 1-year mortality declined among all the stroke patients, with the greatest decline among those treated with both IVT and EVT.