{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T17:11:22Z","timestamp":1784913082425,"version":"3.55.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Whether prior intravenous thrombolysis (IVT) modifies the relative efficacy of first-line thrombectomy strategies remains uncertain, and no randomised trial has specifically addressed this question. Leveraging the randomised design of the VECTOR trial, a multicentre trial comparing first-line contact aspiration (CA) vs CA plus stent retriever (SR\u00a0+\u00a0CA) in patients with anterior LVOs and a positive susceptibility vessel sign, we assessed whether IVT status modified the association between thrombectomy strategy and reperfusion outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>We performed a secondary analysis of the VECTOR trial, in which patients were stratified according to prior IVT use. The primary outcome was near-complete or complete reperfusion (expanded thrombolysis in cerebral infarction [eTICI] 2c-3) after \u2264\u20093 passes with the assigned first-line technique and before rescue therapy. Secondary outcomes included first-pass reperfusion, complete reperfusion after \u2264\u20093 passes, final reperfusion at the end of the procedure and functional outcomes at 90\u00a0days.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 26 November 2019 and 14 February 2022, 521 patients were included in VECTOR. Of these, 288 (55%) received IVT before thrombectomy. The effect of first-line strategy on the primary outcome did not differ according to IVT status (P for heterogeneity\u00a0=\u00a0.28). Among IVT-treated patients, eTICI 2c-3 after \u2264\u20093 passes occurred in 88\/144 patients (61.1%) assigned to SR\u00a0+\u00a0CA vs 74\/144 (51.3%) assigned to CA (aOR, 1.50 [95% CI, 0.91\u20132.45]). Among patients without IVT, corresponding rates were 64\/119 (53.9%) vs 61\/114 (53.6%) (aOR, 1.00 [95% CI, 0.58\u20131.72]). Interaction tests were non-significant for all other angiographic, clinical and safety outcomes except final complete reperfusion, which favoured CA in patients without IVT (P for heterogeneity\u00a0=\u00a0.019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Prior IVT did not significantly modify the effect of first-line strategy on early reperfusion, and both CA and SR + CA remained valid approaches irrespective of IVT status. The isolated interaction for final complete reperfusion, favouring CA in patients without IVT, was exploratory and may reflect chance. A hypothesis-generating mechanism is plausible in this SVS-positive, red blood cell\u2013rich phenotype: CA applied to an intact clot may favour en-bloc retrieval, an advantage attenuated once alteplase softens the thrombus. These results, obtained almost exclusively under alteplase and in an MRI-selected population with mandatory balloon guide catheter use, may not extend to tenecteplase or CT-selected patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this secondary analysis of the VECTOR trial, prior IVT did not significantly modify the association between first-line thrombectomy strategy and successful reperfusion. The observed angiographic differences remain exploratory and warrant further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/aakag087","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T16:59:13Z","timestamp":1784912353000},"source":"Crossref","is-referenced-by-count":0,"title":["Impact of prior intravenous thrombolysis on first-line thrombectomy strategy. A secondary analysis of the VECTOR trial"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2239-1017","authenticated-orcid":false,"given":"Samuel J","family":"Mouyal","sequence":"first","affiliation":[{"name":"Interventional Neuroradiology Department, Rothschild Foundation Hospital , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Ma\u00efer","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department, Rothschild Foundation Hospital , Paris ,","place":["France"]},{"name":"Neurology Department, H\u00f4pital Paris Saint-Joseph , Paris ,","place":["France"]},{"name":"FHU NeuroVasc, INSERM UMRS 1144, Universit\u00e9 Paris Cit\u00e9 , Paris ,","place":["France"]},{"name":"Stroke-Link F-CRIN Research Network , Lille ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Labreuche","sequence":"additional","affiliation":[{"name":"EA 2694-Sant\u00e9 Publique: \u00e9pid\u00e9miologie et qualit\u00e9 des soins, University of Lille, CHU Lille , Lille ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Philippe","family":"Desilles","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department, Rothschild Foundation Hospital , Paris ,","place":["France"]},{"name":"FHU NeuroVasc, INSERM UMRS 1144, Universit\u00e9 Paris Cit\u00e9 , Paris ,","place":["France"]},{"name":"Stroke-Link F-CRIN Research Network , Lille ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0911-8999","authenticated-orcid":false,"given":"Mikael","family":"Mazighi","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department, Rothschild Foundation Hospital , Paris ,","place":["France"]},{"name":"FHU NeuroVasc, INSERM UMRS 1144, Universit\u00e9 Paris Cit\u00e9 , Paris ,","place":["France"]},{"name":"Stroke-Link F-CRIN Research Network , Lille ,","place":["France"]},{"name":"Neurology Department, H\u00f4pital Lariboisi\u00e8re, APHP, Institut Universitaire de France , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romain","family":"Bourcier","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department, CHU Nantes , Nantes ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hocine","family":"Redjem","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology Department, Rothschild Foundation Hospital , Paris 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