Is Bridging with Intravenous Thrombolysis of Any Benefit in Endovascular Therapy for Acute Ischemic Stroke?

Kass‐Hout, Tareq; Kass‐Hout, Omar; Mokin, Maxim; Thesier, Danielle M.; Yashar, Parham; Orion, David; Jahshan, Shady; Hopkins, L. Nelson; Siddiqui, Adnan H.; Snyder, Kenneth V.; Levy, Elad I.

doi:10.1016/j.wneu.2013.01.097

Cited by 52 publications

(55 citation statements)

References 19 publications

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Section: Discussionmentioning

confidence: 99%

“…[21][22][23] However, all 3 studies had major confounders. In the study of Kass-Hout et al 21 , bridging patients were treated significantly later than patients with direct EVT and patients in the endovascular arm could also receive tPA endovascularly, making direct comparison difficult. In the study of Leker et al 22 and Sallustio et al, 23 direct MT was only performed in patients with contraindications for intravenous tPA.…”

Section: Discussionmentioning

confidence: 99%

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Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke

Broeg-Morvay

Mordasini

Bernasconi

et al. 2016

Stroke

122

109

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Background and Purpose-Five randomized controlled trials have consistently shown that mechanical thrombectomy (MT) in addition to best medical treatment (±intravenous tissue-type plasminogen activator) improves outcome after acute ischemic stroke in patients with large artery anterior circulation stroke. Whether direct MT is equally effective as combined intravenous thrombolysis with MT (ie, bridging thrombolysis) remains unclear. Methods-We retrospectively compared clinical and radiological outcomes in 167 bridging patients with 255 patients receiving direct MT because of large artery anterior circulation stroke. We matched all patients from the direct MT group who would have qualified for intravenous tissue-type plasminogen activator with controls from the bridging group, using multivariate and propensity score analyses. Functional independence was defined as modified Rankin Scale score of 0 to 2. Results-From February 2009 to August 2014, 40 patients from the direct MT group would have qualified for bridging thrombolysis but were treated with MT only. Clinical and radiological characteristics did not differ from the bridging cohort, except for higher rates of hypercholesterolemia (P=0.019), coronary heart disease (P=0.039), and shorter intervals from symptom onset to endovascular intervention (P=0.01) in the direct MT group. Functional independence, mortality, and intracerebral hemorrhage rates did not differ (P>0.1). After multivariate matching analysis outcome in both groups did not differ, except for lower rates of asymptomatic intracerebral hemorrhage (P=0.023) and lower mortality (P=0.007) in the direct MT group. Conclusions-In patients with large anterior circulation stroke, direct mechanical intervention seems to be equally effective as bridging thrombolysis. A randomized trial comparing direct MT with bridging therapy is warranted. (Stroke.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke

Broeg-Morvay

Mordasini

Bernasconi

et al. 2016

Stroke

122

109

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“…In the IMS III trial, time to endovascular therapy was longer than in IMS I and IMS II trials despite great emphasis on time. Kass-Hout et al demonstrated similar outcome, revascularization rate, SICH occurrence, and mortality rate in 106 patients treated either by IVT + IAT or IAT alone 58 . Nevertheless, the endovascular group was treated significantly earlier than the combined group (125±40 vs. 227±88 min; P<0.0001).…”

Section: Bridging Therapymentioning

confidence: 87%

“…39,54,55 ) or glycoprotein IIb/IIIa inhibitors abciximab and tirofiban, with a high recanalization rate of endovascular techniques 14,24,44,46 . Despite published data from 2 meta-analyses supporting bridging therapy as a therapeutic approach in patients with large vessel occlusion 56,57 recent studies report no significant difference in functional outcome between bridging and IVT alone and endovascular treatment alone 58,59 . Georgiadis et al compared IVT vs. combination of IV and IA thrombolysis in his meta-analysis comprising 11 studies with a total of 457 patients 57 .…”

Section: Bridging Therapymentioning

confidence: 99%

Management of acute basilar artery occlusion: Should any treatment strategy prevail?

Dorňák

Herzig²,

Šaňák³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Background. Acute basilar artery occlusion (BAO) is relatively infrequent form of acute ischemic stroke associated with severe and persisting neurological deficit and high mortality rate (to 86%). Early recanalization is essential for good clinical outcome but the most effective treatment approach remains unestablished. Several treatment strategies are currently available but their safety and efficacy have only been tested in retrospective/prospective case series. Randomized controlled trials (RCTs) are lacking. Methods and Results. We searched the PubMed database for assessments of recanalization rate and clinical outcome in BAO patients treated with various treatment methods. The results show that antithrombotics are least effective while specific reperfusion therapies including intravenous thrombolysis (IVT) and various types of intra-arterial therapy (IAT) are more so. Less than half of BAO patients reach independent outcome following IVT with a recanalization rate 52 -78%. Even though IAT recanalizes BAO more frequently (in up to 100%), the higher recanalization rate is not necessarily associated with better outcome. Conclusions. Good clinical outcome is strongly dependent on recanalization time. Thus, the concept of bridging therapy, combining widely available IVT with IAT, was introduced and is usually considered a rescue strategy in nonresponders to IV alteplase. A trend to better outcome in patients treated with bridging therapy in some studies, has to be confirmed by large RCTs.

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“…As a current approach to improve outcomes in patients with acute ischemic stroke, many stroke centers start IV tPA (either full-dose or part-dose) during the transfer for IA thrombectomy or stenting -an approach known as bridging therapy. [10] In early 2013, the results of three RCTs have been published in the New England Journal of Medicine that generates Class Ia evidence that demonstrates the absence of any therapeutic superiority of EVT over IV tPA. This, therefore, compels one to evaluate more thoroughly and rigorously the role of EVT in acute stroke.…”

Section: Introductionmentioning

confidence: 99%

Endovascular therapy for acute stroke: Quo vadis?

Madhugiri¹,

Pandey

2013

IJNS

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Is Bridging with Intravenous Thrombolysis of Any Benefit in Endovascular Therapy for Acute Ischemic Stroke?

Cited by 52 publications

References 19 publications

Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke

Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke

Management of acute basilar artery occlusion: Should any treatment strategy prevail?

Endovascular therapy for acute stroke: Quo vadis?

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