Bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion

Abstract

BACKGROUND Intravenous thrombolysis is an important treatment for cerebral infarction. However, it is difficult to achieve good results if the patient is complicated with anterior circulation macrovascular occlusion. In addition, the vascular recanalization rate is low, so mechanical thrombectomy, that is, bridging therapy, is needed AIM To investigate the efficacy and safety of bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion. METHODS Ninety-six patients in our hospital with cardiogenic cerebral infarction with anterior circulation macrovascular occlusion from January 2017 to July 2020 were divided into a direct thrombectomy group ( n = 48) and a bridging group ( n = 48). Direct mechanical thrombectomy was performed in the direct thrombectomy group, and bridging therapy was used in the bridging treatment group. Comparisons were performed for the treatment data of the two groups (from admission to imaging examination, from admission to arterial puncture, from arterial puncture to vascular recanalization, and from admission to vascular recanalization), vascular recanalization rate, National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores before and after treatment, prognosis and incidence of adverse events. RESULTS In the direct thrombectomy group, the time from admission to imaging examination was 24.32 ± 8.61 min, from admission to arterial puncture was 95.56 ± 37.55 min, from arterial puncture to vascular recanalization was 54.29 ± 21.38 min, and from admission to revascularization was 156.88 ± 45.51 min, and the corresponding times in the bridging treatment group were 25.38 ± 9.33 min, 100.45 ± 39.30 min, 58.14 ± 25.56 min, and 161.23 ± 51.15 min; there were no significant differences between groups ( P =0.564, 0.535, 0.426, and 0.661, respectively). There was no significant difference in the recanalization rate between the direct thrombectomy group (79.17%) and the bridging group (75.00%) ( P = 0.627). There were no significant differences between the direct thrombectomy group (16.69 ± 4.91 and 12.12 ± 2.07) and the bridging group (7.13 ± 1.23 and (14.40 ± 0.59) in preoperative NIHSS score and GCS score ( P = 0.200 and 0.203, respectively). After the operation, the NIHSS scores in both groups were lower than those before the operation, and the GCS scores were higher than those before the operation. There was no significant difference in NIHSS and GCS scores between the direct thrombectomy group (6.91 ± 1.10 and 14.19 ± 0.65) and the bridging group (7.13 ± 1.23 and 14.40 ± 0.59) ( P = 0.358 and 0.101, respectively). There was no significant difference in the proportion of patients who achieved a good prognosis betwe...

Intravenous Thrombolysis Combined with Arterial Thrombolysis (Bridging Therapy) Effectively Improves Vascular Recanalization Rate in Patients with Cerebral Infarction

“…Although arterial thrombolysis, as an interventional method, causes certain trauma, the proportion of patients with postoperative complications after bridging therapy did not increase significantly compared with those treated with intravenous thrombolysis alone, suggesting that the combined treatment is safe [20]. Previous studies have found that bridging therapy can safely treat patients with cardiogenic cerebral infarction complicated with anterior circulation macrovascular occlusion, contributing to good vascular recanalization effects and patient prognosis, as well as improved Journal of Immunology Research neurological function of patients [21], which corroborates our observations. Inflammation, which is positively correlated with the severity of cerebral infarction, is essential in the pathogenesis and progression of the disease and acts as an independent pathogenic factor for clinical prognosis and disease outcome assessment of patients [22].…”

Direct Mechanical Thrombectomy vs. Bridging Therapy in Stroke Patients in A “Stroke Belt” Region of Southern Europe

“…Nie et al reported better results with BT in patients with basilar artery occlusions [ 40 ]. In two studies, the efficacy of BT was evaluated in patients with a cardioembolic stroke, showing no differences and a worse functional outcome in the BT group, respectively [ 41 , 42 ]. There is also no consensus regarding tandem carotid occlusions, with some data supporting a better prognosis with BT and others showing a higher mortality in this group [ 32 , 38 ].…”