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Updated: Aug 13, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Bridging Therapy Versus Intravenous Thrombolysis Alone in Patients With Medium Vessel Occlusion Stroke: A
Di Hu1,2, Mo Yang2, Zhenghua Gu2
1School of Medicine, Southeast University, Nanjing, Jiangsu, PR China.
Insights
Bridging therapy did not improve outcomes for medium vessel occlusion (MeVO) patients compared to intravenous thrombolysis (IVT) alone. Functional independence and symptomatic intracranial hemorrhage rates were similar between the groups.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Medium vessel occlusion (MeVO) stroke management remains a challenge.
- Intravenous thrombolysis (IVT) is a standard treatment, but its efficacy in MeVO is debated.
- Bridging therapy, combining IVT with endovascular treatment, is an alternative approach.
Purpose of the Study:
- To compare the effectiveness of bridging therapy versus IVT alone in MeVO patients.
- To evaluate outcomes including favorable functional status and symptomatic intracranial hemorrhage.
Main Methods:
- Retrospective analysis of consecutive MeVO patients treated with IVT.
- Classification into IVT alone or bridging therapy groups.
- Inverse probability weighting (IPW) and logistic regression for covariate balancing and treatment association assessment.
Main Results:
- No significant difference in favorable outcomes (mRS 0-1) between bridging therapy and IVT alone (59.3% vs. 62.2%).
- Bridging therapy was not associated with improved functional independence (mRS 0-2) or increased risk of symptomatic intracranial hemorrhage (sICH).
- Sensitivity analyses confirmed the robustness of these findings.
Conclusions:
- Bridging therapy does not offer significant outcome benefits over IVT alone in MeVO patients.
- Current evidence suggests IVT alone may be sufficient for selected MeVO cases.
- Further research may explore specific MeVO patient subgroups who could benefit from bridging therapy.
Background:
To compare the outcomes of bridging therapy versus intravenous thrombolysis (IVT) alone in patients with medium vessel occlusion (MeVO).
Methods:
Consecutive MeVO patients between January 2019 and December 2024 were retrospectively included and classified into IVT alone or bridging therapy groups. The primary outcome was a favorable outcome, defined as a modified Rankin Scale score of 0-1 at 90 days. Secondary outcomes included functional independence (mRS 0-2), symptomatic intracranial hemorrhage (sICH). Inverse probability weighting (IPW) and IPW-adjusted logistic regression were used to balance baseline covariates and assess treatment associations. Per-protocol and as-treated sensitivity analyses were performed to assess the robustness of the primary findings.
Results:
A total of 248 patients with MeVO treated with IVT were included, of whom 86 received bridging therapy. After IPW adjustment, there was no significant difference in the rate of favorable outcome between the bridging therapy and IVT alone groups (59.3% vs. 62.2%; adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 0.75-1.99). Similarly, bridging therapy was not associated with improved functional independence (73.5% vs. 76.3%; aOR, 1.18; 95% CI, 0.66-2.12) or increased risk of sICH (8.0% vs. 5.9%; aOR, 1.37; 95% CI, 0.50-3.75). Both per-protocol and as-treated sensitivity analyses yielded similar results.
Conclusions:
Bridging therapy did not improve overall outcomes compared with IVT alone in MeVO patients.
