The safety and efficacy of bridging full-dose IV-IA thrombolysis in acute ischemic stroke patients with MCA occlusion: A comparison with IV thrombolysis alone

Abstract

Aims. Early recanalization of the occluded cerebral artery is substantial for clinical improvement in acute ischemic stroke (IS) patients. The rate of achieved recanalizations using IVT is low. The aim of this study was to compare the safety and efficacy of bridging full-dose intravenous-intraarterial (IV-IA) thrombolysis to IVT alone in acute IS patients with occluded MCA. Methods. Seventy-nine consecutive IS patients with MCA occlusion were treated either with IVT alone (historic controls, Group 1) or with full-dose IV-IA thrombolysis (Group 2). Stroke severity was evaluated using NIHSS, achieved recanalizations using transcranial Doppler (Group 1) or angiography (Group 2). Occurrence of ICH including SICH was evaluated after 24 hours. 90-day clinical outcome was evaluated using modified Rankin Scale (mRS). Results. Group 1 consisted of 50 patients (24 males, mean age 70.8 ± 10.2 years) and Group 2 of 29 patients (14 males, mean age 67.8 ± 10.0 years). No difference was found in the initial NIHSS (median 16 vs. 17) and other baseline parameters including time from stroke onset to IVT. Patients treated with bridging therapy had a higher number of achieved MCA recanalization (75.9 vs. 32.0%, P=0.0002), similar number of SICH (6.0 vs. 6.9%, P =1.000) and 34.5% of them achieved mRS 0-2 versus 28.0% of patients treated with IVT (P=0.546). Patients with shorter TR had significantly better clinical outcome (P=0.019). Conclusion. Bridging IV-IA thrombolysis seems to be safe and more effective than IVT alone in acute stroke patients with MCA occlusion.

Comparison of Mechanical Thrombectomy with Contact Aspiration, Stent Retriever, and Combined Procedures in Patients with Large-Vessel Occlusion in Acute Ischemic Stroke

“…Prior IVT administration can increase the risk of symptomatic or non-symptomatic ICH [7,42,45,46]. We did not find any significant differences in the number of symptomatic ICH events between treatment groups treated with/without IVT prior to mechanical thrombectomy (Table 5).…”

Efficacy and safety of mechanical thrombectomy alone for the treatment of acute ischemic stroke

“…After reading their titles and abstracts, 468 irrelevant studies were removed. After intensive reading, an additional 15 studies were removed, 2 of which used IVT alone as the control group 17,18 , 7 of which were reviews [19][20][21][22][23][24][25] , 4 of which were meta-analyses on MT [26][27][28][29] , and 2 of which were meta-analyses on IVT. 30,31 Finally, 35 studies were selected for this systematic review and meta-analysis.…”