To observe the clinical efficacy and safety of tenecteplase bridging endovascular thrombectomy versus direct thrombectomy in the treatment of acute basilar artery occlusion stroke.

Patients with acute basilar artery occlusion stroke were collected and divided into a control group and an experimental group based on different treatment methods. Compared the differences in clinical efficacy, vascular recanalization rate, thrombectomy-related indicators, infarct-related parameters, cerebral hemodynamic indicators, serum biomarkers, neurological function, 90-day prognosis, and adverse reactions between the two groups.

A total of 112 patients with acute basilar artery occlusion stroke were enrolled, including 57 cases in the control group and 55 cases in the experimental group. After treatment, the overall effective rate of the experimental group was 52.73% (29 cases/55 cases), which was higher than that of the control group 33.33%,(19 cases/57 cases) (P<0.05). At the time of treatment, the effective recanalization rates in the experimental group and the control group were 85.45% (47 cases/55 cases) and 80.70% (46 cases/57 cases), respectively, while the complete recanalization rates were 56.36% (31 cases/55 cases) and 49.12% (28 cases/57 cases), respectively. There was no statistically significant difference in the above indicators between the two groups (P>0.05). The first-pass effect (FPE) rates in the experimental group and the control group were 72.73% (40 cases/55 cases) and 52.63% (30 cases/57 cases), respectively, and the number of thrombectomy procedures was 1.91±0.48 and 2.11±0.52, respectively, with statistically significant differences (P<0.05). The thrombectomy time in the experimental group and the control group was (64.29±10.29) and (66.37±12.32) min, respectively, and the residual stenosis rates were 10.91% (6 cases/55 cases) and 21.05% (12 cases/57 cases), respectively, with no statistically significant differences (P>0.05). At 24 hours after the operation, the ischemic area volume of the experimental group and the control group was (82.66±15.21) and (93.61±18.65) mL. respectively, the ischemic core volume was (60.19±8.52) and (65.15±9.10) mL, respectively, the ischemic penumbra volume was (22.47±5.18) mL and (28.46±7.22) mL, respectively, the final infarct growth volume was (30.47±8.16) and (35.04±9.04) mL, respectively, the salvage rates of the ischemic penumbra were (69.93±8.11)% and (64.71±7.52)%, respectively, and the peak systolic velocity was (119.86±28.79) and (105.24±24.35) cm·s^-1, respectively, the end-diastolic velocity was (44.44±7.16) and (34.89±8.05) cm·s^-1, respectively; the resistance index (RI) was 0.63±0.04 and 0.67±0.05, respectively; the pulsatility index (PI) was 0.70±0.07 and 0.74±0.06, respectively; The serum neurofilament light chain (NfL) levels were (345.26±30.15) and (372.34±54.19) pg·mL^-1, respectively, and the glial fibrillary acidic protein (GFAP) levels were (526.37±74.91) and (566.42±82.21) pg·mL^-1, respectively. There were statistically significant differences in the above indicators between the two groups (P<0.05). At 7 days, 30 days postoperatively, the NIHSS scores of the experimental group were (10.42±2.13), (7.47±1.92) points, respectively, all of which were lower than those of the control group [(11.56±2.29), (8.37±2.04) points]. During the follow-up period, 11 bleeding events occurred in the experimental group, including 4 cases of symptomatic intracerebral hemorrhage (sICH), 6 cases of asymptomatic intracerebral hemorrhage (aICH), and 1 case of upper gastrointestinal bleeding; 9 bleeding events occurred in the control group, including 4 cases of sICH and 5 cases of aICH. The difference was not statistically significant (P>0.05). The rate of favorable prognosis at 90 days was 54.55% (30 cases/55 cases) in the experimental group, which was higher than the 33.33% (19 cases/57 cases) in the control group (P<0.05). There were no significant differences between the two groups in all-cause mortality or re-infarction rate (P>0.05). The overall incidence of adverse reactions was 9.09% (5 cases/55 cases) in the experimental group and 10.53% (6 cases/57 cases) in the control group, with no statistically significant difference between the groups (P>0.05).

For patients with acute basilar artery occlusion stroke with onset <6 hours, ASA grade ≤Ⅲ, and baseline mRS 0-2, tenecteplase bridging endovascular thrombectomy and direct thrombectomy achieve similar recanalization outcomes in the treatment of acute basilar artery occlusion stroke. The bridging approach reduces the number of thrombectomy attempts required, further improves cerebral blood flow perfusion, promotes neurological function and prognosis, while maintaining a safety profile comparable to that of direct thrombectomy.