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Direct Mechanical Thrombectomy vs. Bridging Therapy in Stroke Patients in A "Stroke Belt" Region of Southern Europe
Cristina Del Toro-Pérez1, Laura Amaya-Pascasio1, Eva Guevara-Sánchez1
1Stroke Centre, Department of Neurology, Torrecárdenas University Hospital, University of Almería, 04009 Almería, Spain.
Insights
Bridging therapy (BT) showed better outcomes than direct mechanical thrombectomy (dMT) for stroke patients in Southern Europe. BT was linked to excellent functional recovery and reduced mortality at three months.
Area of Science:
- Neurology
- Cardiovascular Diseases
- Public Health
Background:
- Stroke remains a leading cause of disability and mortality globally.
- Mechanical thrombectomy has emerged as a critical intervention for acute ischemic stroke.
- Direct mechanical thrombectomy (dMT) and bridging therapy (BT) are two primary treatment strategies.
Purpose of the Study:
- To compare the 3-month outcomes of stroke patients treated with dMT versus BT in real-world clinical practice.
- To investigate treatment efficacy in the unique context of Southern Europe's "Stroke Belt" region.
Main Methods:
- An observational study involving 300 stroke patients over 4 years.
- Patients were divided into dMT (41.3%) and BT (58.6%) groups.
- Outcomes analyzed included recanalization rates, hemorrhagic transformation, functional outcomes, and mortality at 3 months.
Main Results:
- Bridging therapy (BT) was associated with a longer time from onset to groin intervention compared to dMT (399 vs. 210 minutes).
- Successful recanalization (TICI 2b-3) and hemorrhagic transformation rates were similar between the groups.
- The BT group demonstrated significantly higher rates of excellent functional outcomes (32.4% vs. 15.4%) and lower 3-month mortality.
Conclusions:
- In this real-world setting, bridging therapy (BT) was independently associated with excellent functional outcomes and reduced mortality compared to direct mechanical thrombectomy (dMT).
- The findings highlight the importance of considering regional healthcare specificities and patient selection for optimal stroke treatment strategies.
Abstract:
The aim of this 4-year observational study is to analyze the outcomes of stroke patients treated with direct mechanical thrombectomy (dMT) compared to bridging therapy (BT) (intravenous thrombolysis [IVT] + BT) based on 3-month outcomes, in real clinical practice in the "Stroke Belt" of Southern Europe. In total, 300 patients were included (41.3% dMT and 58.6% BT). The frequency of direct referral to the stroke center was similar in the dMT and BT group, whereas the time from onset to groin was longer in the BT group (median 210 [IQR 160-303] vs. 399 [IQR 225-675], p = 0.001). Successful recanalization (TICI 2b-3) and hemorrhagic transformation were similar in both groups. The BT group more frequently showed excellent outcomes at 3 months (32.4% vs. 15.4%, p = 0.004). Multivariate analysis showed that BT was independently associated with excellent outcomes (OR 2.7. 95% CI,1.2-5.9, p = 0.02) and lower mortality (OR 0.36. 95% CI 0.16-0.82, p = 015). Conclusions: Compared with dMT, BT was associated with excellent functional outcomes and lower 3-month mortality in this real-world clinical practice study conducted in a region belonging to the "Stroke Belt" of Southern Europe. Given the disparity of results on the benefit of BT in the current evidence, it is of vital importance to analyze the convenience of its use in each health area.
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