Bridging therapy in acute ischemic stroke: a systematic review and meta-analysis

Pending the results of randomized controlled trials, the benefit and safety of bridging therapy (combined intravenous and intra-arterial thrombolysis) remain to be determined. The aim of this analysis was to give reliable estimates of efficacy and safety outcomes of bridging therapy.

We conducted a systematic review of all studies using bridging therapy published between January 1966 and March 2011.

The literature search identified 15 studies. The pooled estimate for recanalization rate was 69.6% (95% CI, 63.9%-75.0%). Meta-analysis on clinical outcomes showed a pooled estimate of 48.9% (95% CI, 42.9%-54.9%) for favorable outcome, 17.9% (95% CI, 12.7%-23.7%) for mortality, and 8.6% (95% CI, 6.8%-10.6%) for symptomatic intracranial hemorrhage. In meta-regression analysis, the shorter mean time to intravenous treatment, the greater the recanalization rate (per 10-minute decrease: OR, 1.24; 95% CI, 1.02-1.51) and the lower mortality rate (per 10-minute decrease: OR, 0.75; 95% CI, 0.60-0.94). By using the control groups of intravenous alteplase-treated patients in 8 studies, bridging therapy was associated with a favorable outcome (OR, 2.26; 95% CI, 1.16-4.40), but no differences in mortality or symptomatic intracranial hemorrhage outcomes were found.

Bridging therapy is associated with acceptable safety and efficacy in stroke patients. Time to intravenous treatment is critical to improve recanalization rates and favorable outcomes.