Related Experiment Video
Updated: Jun 17, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Bridging thrombolysis before endovascular therapy is associated with better outcomes in patients with large
Yu Guo1, Yong-Gang Xu2, Chao Liu2
1Department of Neurosurgery, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou, China.
Insights
Bridging intravenous thrombolysis (IVT) before endovascular therapy (EVT) improves functional outcomes in large infarction core stroke patients. However, this approach increases the risk of symptomatic intracranial hemorrhage (sICH).
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Large infarction core strokes present unique treatment challenges.
- Endovascular therapy (EVT) is a primary treatment, but outcomes can be improved.
- Investigating adjunctive therapies like intravenous thrombolysis (IVT) is crucial.
Purpose of the Study:
- To compare the efficacy and safety of bridging IVT followed by EVT versus EVT alone.
- To evaluate outcomes in patients with large ischemic stroke cores (ASPECTS ≤5 or core volume ≥50 mL).
Main Methods:
- A systematic literature review and meta-analysis of studies published between January 2015 and June 2024.
- Searched databases: PubMed, EMBASE, and Cochrane Library.
- Analyzed data from 9 observational studies involving 2641 patients, focusing on functional outcomes, reperfusion, sICH, and mortality.
Main Results:
- Bridging IVT + EVT significantly improved 90-day functional independence (mRS 0-2) and overall functional outcome (mRS 0-3) compared to EVT alone.
- No significant differences were observed in successful reperfusion rates or 90-day mortality between the groups.
- The IVT + EVT group showed a higher incidence of symptomatic intracranial hemorrhage (sICH).
Conclusions:
- Bridging IVT before EVT is associated with better functional outcomes in patients with large infarction core strokes.
- Despite improved outcomes, the increased risk of sICH with bridging therapy must be considered.
- Further randomized controlled trials are warranted to validate these findings.
Background:
This study investigates the efficacy and safety of bridging intravenous thrombolysis (IVT) before endovascular therapy (EVT) compared with EVT alone in patients with large infarction core.
Methods:
We conducted a comprehensive search of PubMed, EMBASE, and the Cochrane Library from January 2015 to June 2024. Included studies involved patients with acute ischemic stroke with an Alberta Stroke Program Early CT Score of ≤5 or an ischemic core volume of ≥50 mL. Studies were required to provide either 90-day modified Rankin Scale (mRS) score, reperfusion, symptomatic intracranial hemorrhage (sICH), or 90-day mortality.
Results:
Nine observational studies with 2641 patients were analyzed. The IVT+EVT group had a higher rate of 90-day functional independence (mRS 0-2; OR 1.56, 95% CI 1.31 to 1.87; adjusted OR (aOR) 1.43, 95% CI 1.21 to 1.68) and 90-day functional outcome (mRS 0-3; OR 1.34, 95% CI 1.11 to 1.62; aOR 1.18, 95% CI 1.02 to 1.37) compared with EVT alone. There was no significant difference in successful reperfusion (OR 1.01, 95% CI 0.62 to 1.64; aOR 1.07, 95% CI 0.74 to 1.54) and 90-day mortality (OR 0.86, 95% CI 0.73 to 1.02; aOR 0.89, 95% CI 0.77 to 1.04) between the two groups. Moreover, patients who received IVT+EVT had a higher rate of sICH (OR 1.30, 95% CI 1.03 to 1.64; aOR 2.21, 95% CI 1.22 to 4.01).
Conclusions:
In patients with large infarction core, bridging IVT before EVT is associated with favorable functional outcomes compared with EVT, even though bridging therapy entails a higher risk of sICH. Further trials are needed to confirm these findings.
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