目的：比较桥接治疗（静脉溶栓+血管内治疗）与直接血管内治疗（endovascular treatment，EVT）在急性 后循环大血管闭塞性缺血性卒中（posterior circulation- large vessel occlusion，PC-LVO）患者中的疗效与安全 性。方法：本研究为单中心回顾性队列研究。纳入符合条件的PC-LVO患者110例，其中桥接组66例（发病 ≤4.5 h内行静脉rt-PA后行EVT），直接EVT组44例[发病至股动脉穿刺时间（onset-to-puncture time，OPT） 可延长至24 h]。收集并比较2组患者的临床资料，包括年龄、性别、高血压、糖尿病、房颤史、入院美国国立 卫生院脑卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分、麻醉方式、OPT及时间窗分层等 基线特征。主要疗效终点为术后90 d改良Rankin量表（modified Rankin Scale，mRS）评分为0～3分（预后良 好）的比例；安全性指标包括症状性颅内出血（symptomatic intracerebral hemorrhage，sICH）发生率和90 d死 亡率。采用多因素Logistic回归分析评价桥接治疗与良好预后（mRS≤3分）的相关性，并校正基线差异和 时间因素。结果：2组基线特征除OPT外，差异均无统计学意义（P＞0.05），桥接组OPT较短[200(150, 240) min vs 480(320, 720) min，P＜0.001）。桥接组90 d预后良好率为53.0%（35/66），直接组为40.9%（18/44），差 异无统计学意义（P=0.16）；桥接组sICH发生率略高于直接组（9.1% vs 4.5%，P=0.38）；90 d死亡率桥接组为 25.8%，直接组为18.2%（P=0.34）。多因素Logistic回归分析显示，桥接治疗与90 d预后良好结局无明显相 关性（P=0.30），高NIHSS评分是预后不良的独立危险因素（P＜0.01），而年龄偏大仅表现出不利预后趋势 （P=0.20），OPT延长则与预后不良显著相关（每延迟1 h，OR≈0.61，P=0.04）。敏感性分析（仅考虑OPT≤6 h 患者）结果与主分析一致。结论：在本回顾性队列中，PC-LVO患者桥接治疗组与直接EVT组在功能预后和 死亡率方面差异无统计学意义。未来大样本随机研究可进一步验证桥接治疗在后循环卒中的作用。

To compare the efficacy and safety of bridging therapy (intravenous thrombolysis plus endovascular treatment) versus direct endovascular treatment (EVT) in patients with acute posterior circulation large vessel occlusion (PC-LVO). Methods: This was a single-center, retrospective cohort study. A total of 110 eligible patients with PC-LVO were enrolled, comprising 66 in the bridging group (receiving intravenous rt-PA within 4.5 hours of onset followed by EVT) and 44 in the direct EVT group [with onset-to-puncture time (OPT) extendable up to 24 hours). Clinical data were collected and compared between the two groups, including baseline characteristics such as age, sex, hypertension, diabetes, history of atrial fibrillation, admission National Institutes of Health Stroke Scale (NIHSS) score, anesthesia method, OPT, and time window stratification. The primary efficacy endpoint was the proportion of patients with a modified Rankin Scale (mRS) score of 0-3 at 90 days (good outcome). Safety indicators included the incidence of symptomatic intracerebral hemorrhage (sICH) and 90-day mortality. Multivariate Logistic regression analysis was performed to evaluate the association between bridging therapy and good outcome (mRS≤3), adjusting for baseline differences and time factors. Results: There were no statistically significant differences in baseline characteristics between the two groups except for OPT (P>0.05); the bridging group had a shorter OPT [200 (150, 240) min vs 480 (320, 720) min, P< 0.001]. The 90-day good outcome rate was 53.0% (35/66) in the bridging group and 40.9% (18/44) in the direct group, with no statistically significant difference (P=0.16). The incidence of sICH in the bridging group was slightly higher than that in the direct group (9.1% vs 4.5% , P=0.38). The 90-day mortality was 25.8% in the bridging group and 18.2% in the direct group (P=0.34). Multivariate Logistic regression analysis showed no significant association between bridging therapy and a good 90-day outcome (P=0.30). A high NIHSS score was an independent risk factor for poor outcome (P<0.01), while older age showed only a trend toward adverse prognosis (P=0.20). Prolonged OPT was significantly associated with poor outcome (per 1-hour delay, OR≈0.61, P= 0.04). The results of the sensitivity analysis (considering only patients with OPT≤6 hours) were consistent with the main analysis. Conclusion: In this retrospective cohort, there were no statistically significant differences in functional outcome and mortality between the bridging therapy group and the direct EVT group in patients with PC-LVO. Future large-sample randomized studies are needed to further validate the role of bridging therapy in posterior circulation stroke.