Endovascular thrombectomy in anterior circulation stroke and clinical value of bridging with intravenous thrombolysis

• Published in: Acta radiologica (1987) Vol. 60; no. 3; pp. 308 - 314
• Main Authors: Balodis, Arturs, Radzina, Maija, Miglane, Evija, Rudd, Anthony, Millers, Andrejs, Savlovskis, Janis, Kupcs, Karlis
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.03.2019
• Subjects: Aged; Cerebral Angiography; Combined Modality Therapy; Computed Tomography Angiography; Endovascular Procedures - methods; Female; Humans; Male; Operative Time; Postoperative Complications; Prospective Studies; Retreatment; Stroke - diagnostic imaging; Stroke - drug therapy; Stroke - surgery; Thrombectomy - methods; Thrombolytic Therapy - methods; Tomography, X-Ray Computed; Treatment Outcome; thrombolysis; Thrombectomy; CT perfusion; stroke; bridging; hemorrhage
• ISSN: 0284-1851; 1600-0455
• DOI: 10.1177/0284185118780897

Background Bridging treatment with intravenous thrombolysis (IVT) before endovascular thrombectomy (EVT) in acute ischemic stroke is applied under the assumption of benefits for patients with large vessel occlusion (LVO). However, the benefit of this additional step has not yet been proven. Purpose To compare procedural parameters (procedural time, number of attempts), complications, and clinical outcome in patients receiving EVT vs. patients with bridging treatment. Material and Methods In this prospective study all patients had acute anterior cerebral circulation occlusion and were treated with EVT. All patients were selected for treatment based on clinical criteria, multimodal computed tomography (CT) imaging. Eighty-four patients were treated with bridging IVT followed by EVT; 62 patients were treated with EVT only. Results Bridging therapy did not influence endovascular procedure time (P = 0.71) or number of attempts needed (P = 0.63). Bleeding from any site was more common in the bridging group (27, 32%) vs. the EVT group (12, 19%) (P = 0.09). Functional independence modified Rankin Scale after 90 days was slightly higher in the bridging group (44%) vs. the EVT group (42%) (P = 0.14). Mortality did not differ significantly at 90 days: 17% in the bridging group vs. 21% in EVT alone (P = 0.57). Both treatment methods showed high recanalization rates: 94% in the bridging group and 89% for EVT alone. Conclusion Bridging treatment in LVO did not show benefits or elevated risks of complications in comparison to EVT only. The bridging group did not show significantly better neurological outcome or significant impact on procedural parameters vs. EVT alone.