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Bridging therapy versus direct endovascular thrombectomy in patients with established large infarct: a prospective

Wenzhe Sun1, Jinfu Ma1, Xu Xu1

  • 1Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing.

International Journal of Surgery (London, England)
|August 21, 2024
PubMed

Insights

For patients with large core infarctions, bridging therapy (intravenous thrombolysis before endovascular thrombectomy) may reduce intracranial hemorrhage risk in very elderly individuals and those with severe stroke. Direct EVT showed no significant outcome differences overall.

Area of Science:

  • Neurology
  • Interventional Neurology
  • Stroke Medicine

Background:

  • The optimal treatment strategy for large core infarctions remains controversial.
  • Intravenous thrombolysis (IVT) prior to endovascular thrombectomy (EVT) is debated.

Purpose of the Study:

  • To investigate the association between prior IVT use and outcomes in EVT patients with large core infarctions.
  • To evaluate the effectiveness and safety of bridging therapy versus direct EVT.

Main Methods:

  • Prospective cohort study of 490 patients with large vessel occlusion and ASPECTS 0-5.
  • Primary outcome: favorable functional outcome (90-day mRS 0-3).
  • Secondary outcomes: recanalization rates, intracranial hemorrhage (ICH), and mortality.

Main Results:

  • 122 patients (24.5%) received bridging therapy.
  • Bridging therapy showed no overall association with measured outcomes.
  • Bridging therapy decreased symptomatic ICH risk in very elderly patients and any ICH risk in patients with NIHSS ≥ 20 compared to direct EVT.

Conclusions:

  • Bridging therapy may offer advantages in reducing ICH risk for specific patient subgroups.
  • Very elderly patients and those with high admission NIHSS may benefit from IVT before EVT.
Abstract

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