Bridging Therapy and Direct Thrombectomy for Acute Ischemic Stroke: A Prospective Cohort Study

Abstract

Background: It remains controversial if intravenous thrombolysis (IVT) prior to mechanical thrombectomy (MTE) is superior to MTE alone in patients with acute ischemic stroke caused by large vessel occlusion. We aim to compare functional outcomes, mortality, reperfusion, and intracranial hemorrhage rates in bridging therapy (IVT prior thrombectomy) and MTE alone groups within 6 h from symptom onset. Materials and Methods: Consecutive hospitalized patients (September 2017 and July 2018) with acute large artery occlusion within the anterior cerebral circulation eligible for MTE with or without prior IVT were included. A modified Rankin Scale score of 0 to 2 was considered as good functional outcome at 90 days. Successful reperfusion was defined as a Thrombolysis in Cerebral Infarction scale of 2b to 3. Results: Of the 124 patients included, 56 (45.2%) received bridging therapy and 68 (54.8%) received MTE alone. Patients receiving bridging therapy were younger (median, 56 vs 63, P = .045) and had shorter onset-to-groin time (median, 270 vs 370 min, P < .001) than those receiving MTE alone. Successful reperfusion rate was significantly greater in the bridging therapy group (87.5% vs 72.1%, P = 0.03). There were no statistically significant differences between the 2 groups in functional independence (bridging 58.9% vs 75.0%, P = 0.07), mortality at 90 days (bridging 14.3% vs 7.4%, P = 0.22), parenchymal hematoma type 2 (bridging 3.6% vs 2.9%, P > .99), and any hemorrhage (bridging 42.3% vs 26.5%, P = 0.07). Conclusion: Compared to MTE alone, bridging therapy with IVT improved the reperfusion rate but not other outcomes. Further clinical trials are needed to confirm our findings.

Low-Dose vs. Standard-Dose Intravenous Alteplase in Bridging Therapy Among Patients With Acute Ischemic Stroke: Experience From a Stroke Center in Vietnam

“…Similar high recanalization rates were observed in the Korean ENCHANTED study on a subset of patients receiving alteplase bridging with MTE (low-dose IVT: 85% vs. standard-dose IVT: 76%) (18) and the Taiwanese study (low-dose IVT: 100% vs. standard-dose IVT: 69%) (19). In a study conducted in Southern Vietnam, among those with standard-dose alteplase bridging therapy, the recanalization rate was approximately 88% (onset to groin time ∼270 min) (21). Our study findings showed no significant time delays occurred between drip and groin puncture time (∼40 min; onset to groin time: up to 206 min), which may contribute to the high recanalization rates in both arms, despite a relatively high rate of large artery disease etiology presented in the study (∼50%).…”

Endovascular treatment for acute ischemic stroke beyond the 24-h time window: Selection by target mismatch profile

“…Therefore, future prospective studies with larger sample size are recommended to establish the appropriate (Continued) threshold value of perfusion or ASPECTS-based imaging for EVT in patients presenting beyond 24 h. In Vietnam, the incidence of stroke occurs at a younger age (Table 1) compared to other developing countries. 2,3,18,19 Furthermore, younger stroke patients are associated with better outcomes and fewer complications following EVT compared to older patients. 20 This is particularly important given that young stroke patients have a longer life expectancy, and EVT may have a significant impact on their quality of life.…”

“…In Vietnam, the incidence of stroke occurs at a younger age (Table 1) compared to other developing countries. 2,3,18,19 Furthermore, younger stroke patients are associated with better outcomes and fewer complications following EVT compared to older patients. 20 This is particularly important given that young stroke patients have a longer life expectancy, and EVT may have a significant impact on their quality of life.…”