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

Arturs Balodis, Maija Radzina*, Evija Miglane, Anthony Rudd, Andrejs Millers, Janis Savlovskis, Karlis Kupcs

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

20 Citations (Scopus)

Abstract

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.

Original languageEnglish
JournalActa Radiologica
Early online date6 Jun 2018
DOIs
Publication statusE-pub ahead of print - 6 Jun 2018

Keywords

  • bridging
  • CT perfusion
  • hemorrhage
  • stroke
  • Thrombectomy
  • thrombolysis

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