{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T05:03:46Z","timestamp":1779685426326,"version":"3.53.1"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T00:00:00Z","timestamp":1779667200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Endovascular thrombectomy (EVT) alone is noninferior to bridging therapy for functional outcomes after large-vessel occlusion stroke in patients directly admitted to comprehensive stroke centers, but effects on health-related quality of life (HRQoL) are uncertain. We compared HRQoL between treatment strategies and assessed effect modification by baseline severity and functional outcomes strata.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This secondary analysis of the DIRECT-MT trial compared EVT alone with bridging therapy. HRQoL at 90 days was measured by EQ-5D-5L index. Quantile regression tested treatment effects on median EQ-5D with interaction terms for baseline NIHSS categories (0\u201315, 16\u201320, 21\u201342) and exploratory 90-day BI and mRS strata. EQ-5D dimensions were analyzed using logistic regression for symptom-free status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 656 patients (327 EVT alone; 329 bridging), overall HRQoL among 90-day survivors was similar between groups (median EQ-5D 0.84 vs. 0.85). Baseline stroke severity modified the treatment-EQ-5D association (\n                      <jats:italic>P<\/jats:italic>\n                      for interaction = 0.038), with bridging therapy associated with higher EQ-5D among patients with moderate-to-severe stroke (NIHSS 16\u201320) and severe stroke (NIHSS 21\u201342). In exploratory post-randomization analyses, bridging therapy was favored among patients with near-complete independence (BI 91\u2013100; coefficient \u22120.056; 95% CI \u22120.112 to \u22120.001), whereas EVT alone was associated with lower EQ-5D among those with a favorable functional outcome (mRS 0\u20132; coefficient \u22120.026; 95% CI \u22120.044 to \u22120.009). In dimension-level analyses, EVT alone was associated with lower odds of symptom-free Mobility and Usual activities in the near-independent group (BI 91\u2013100), and a treatment-by-baseline severity interaction was observed for Anxiety\/depression (\n                      <jats:italic>P<\/jats:italic>\n                      for interaction = 0.018).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HRQoL at 90 days was comparable overall between strategies, but differed by baseline stroke severity. Exploratory analyses suggested additional heterogeneity across achieved functional states and EQ-5D dimensions, supporting further evaluation of baseline severity-guided approaches to optimize patient-centered outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1768325","type":"journal-article","created":{"date-parts":[[2026,5,25]],"date-time":"2026-05-25T04:40:15Z","timestamp":1779684015000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Health-related quality of life after direct endovascular thrombectomy and bridging therapy: findings of DIRECT-MT trial"],"prefix":"10.3389","volume":"17","author":[{"given":"Renjun","family":"Gu","sequence":"first","affiliation":[{"name":"Neurovascular Center, Changhai Hospital, Naval Medical University","place":["Shanghai, China"]},{"name":"Key Laboratory of Molecular Neurobiology of Ministry of Education, Naval Medical 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