Thrombectomy with or without Bridging Thrombolysis for Anterior Circulation Stroke

Area of Science:

• Neurology
• Interventional Neurology
• Stroke Medicine

Background:

• No consensus exists on bridging thrombolysis (BT) before mechanical thrombectomy (MT) for stroke.
• This study investigates clinical and procedural outcomes of BT versus direct MT (d-MT) in anterior circulation stroke.

Purpose of the Study:

• To compare clinical outcomes, procedural results, and complication rates between BT and d-MT.
• To evaluate the safety and efficacy of bridging therapy in anterior circulation stroke.

Main Methods:

• Retrospective analysis of 359 anterior circulation stroke patients (Jan 2018-Dec 2020).
• Patients were divided into direct MT (d-MT, n=210) and bridging thrombolysis (BT, n=149) groups.
• Primary outcome: impact of BT on clinical/procedural outcomes; Secondary outcome: safety of BT.

Main Results:

• BT group showed significantly higher rates of good/excellent outcomes (p=0.006, P=0.03).
• The d-MT group had higher incidence of atrial fibrillation (p=0.010) and edema/malignant infarction (p=0.003).
• Procedure duration was longer in d-MT (35 min) vs BT (27 min, P=0.044); reperfusion, hemorrhage, and mortality rates were similar.

Conclusions:

• Bridging thrombolysis (BT) appears to offer better clinical and procedural outcomes with lower complication rates than direct MT (d-MT).
• Findings suggest potential benefits of intravenous alteplase preceding MT in anterior circulation strokes.
• Further large-scale, prospective studies are needed to confirm these real-world findings.