Related Experiment Video
Updated: Apr 21, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Comparable efficacy and safety of bridging therapy versus direct mechanical thrombectomy in anterior circulation
Yurui Xia1, Yiqing Wang1, Huimin Wang1
1Department of Neurology, The First Affiliated Hospital of Soochow University Suzhou 215000, Jiangsu, China.
Objective:
To compare the clinical and procedural outcomes, as well as complication rates, between bridging therapy (BT) and direct mechanical thrombectomy (D-MT) in patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO).
Methods:
In this retrospective cohort study, 169 patients who underwent endovascular therapy (EVT) between January 2021 and January 2024 were included. Patients were divided into a BT group (n=96, intravenous alteplase followed by thrombectomy) and a D-MT group (n=73, thrombectomy alone). Baseline characteristics, procedural data, and 90-day functional outcomes were compared. Multivariable logistic regression identified predictors of 90-day favorable outcome (modified Rankin Scale score 0-2).
Results:
Baseline characteristics were balanced between the groups (all P>0.05). The BT group showed a numerically higher rate of 90-day favorable functional outcome (56.25% vs. 46.58%, P=0.212) and lower mortality rate (4.17% vs. 10.96%, P=0.089), but differences were not statistically significant. Recanalization rates (modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3: ~95%) and complication rates (hemorrhagic transformation, post-awakening stroke) were similar between the groups (all P>0.05). In regression analysis, smoking history, baseline National Institutes of Health Stroke Scale (NIHSS) score, and collateral circulation grade were independent predictors of outcome, while treatment modality was not.
Conclusion:
BT and D-MT demonstrate comparable efficacy and safety in treating anterior circulation LVO. The choice of strategy should consider patient-specific factors such as baseline neurological status and collateral circulation, rather than presumed superiority of either modality.
