Is bridging with intravenous thrombolysis of any benefit in endovascular therapy for acute ischemic stroke?

Tareq Kass-Hout; Omar Kass-Hout; Maxim Mokin; Danielle M Thesier; Parham Yashar; David Orion; Shady Jahshan; L Nelson Hopkins; Adnan H Siddiqui; Kenneth V Snyder; Elad I Levy

doi:10.1016/j.wneu.2013.01.097

Is bridging with intravenous thrombolysis of any benefit in endovascular therapy for acute ischemic stroke?

World Neurosurg. 2014 Sep-Oct;82(3-4):e453-8. doi: 10.1016/j.wneu.2013.01.097. Epub 2013 Feb 1.

Authors

Affiliations

¹ Department of Neurology, University at Buffalo, State University of New York, USA; Department of Neurology, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
² Department of Neurosurgery, University at Buffalo, State University of New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
³ School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, New York, USA.
⁴ Department of Neurosurgery, University at Buffalo, State University of New York, USA.
⁵ Department of Neurosurgery, University at Buffalo, State University of New York, USA; Department of Radiology, University at Buffalo, State University of New York, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
⁶ Department of Neurosurgery, University at Buffalo, State University of New York, USA; Department of Radiology, University at Buffalo, State University of New York, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
⁷ Department of Neurosurgery, University at Buffalo, State University of New York, USA; Department of Radiology, University at Buffalo, State University of New York, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA. Electronic address: elevy@ubns.com.

PMID: 23376392
DOI: 10.1016/j.wneu.2013.01.097

Abstract

Objective: Large vessel occlusions with heavy clot burden are less likely to improve with intravenous (IV) thrombolysis alone. The purpose of this study was to show whether a combination of IV thrombolysis and endovascular therapy was superior to endovascular treatment alone.

Methods: Data for 104 patients with acute large artery occlusion treated between 2005 and 2010 were reviewed. Forty-two received endovascular therapy in combination with IV thrombolysis (bridging group), and 62 received endovascular therapy only. Clinical outcome, mortality rate, and symptomatic intracranial hemorrhage (sICH) rate were compared between the two groups.

Results: The two groups had similar demographic and vascular risk factor distribution, as well as National Institutes of Health Stroke Scale score on admission (mean±SD: 14.8±4.7 and 16.0±5.3; P=0.23). No difference was found in Thrombolysis in Myocardial Infarction recanalization rates (score of 2 or 3) after combined or endovascular therapy alone (83.33% and 79.03%; P=0.585). Favorable outcome, defined as a modified Rankin Scale score of <2 at 90 days, also did not differ between the bridging group and the endovascular-only group (37.5% and 32.76%; P=0.643). There was no difference in mortality rate (19.04% and 29.03%; P=0.5618) and sICH rate (11.9% and 9.68%; P=0.734). A significant difference was found in mean time from symptom onset to treatment in the bridging group and the endovascular-only group (227±88 min vs. 125±40 min; P<0.0001).

Conclusion: Combining IV thrombolysis with endovascular therapy resulted in similar outcome, revascularization, sICH, and mortality rates compared with endovascular therapy alone. Prospective clinical studies comparing both treatment strategies in acute ischemic stroke are warranted.

Keywords: Acute ischemic stroke; Bridging; Intra-arterial therapy; Tissue plasminogen activator.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

MeSH terms

Brain Ischemia / mortality
Brain Ischemia / surgery*
Brain Ischemia / therapy*
Cerebral Infarction / therapy
Endovascular Procedures / methods*
Female
Fibrinolytic Agents / administration & dosage*
Fibrinolytic Agents / therapeutic use*
Humans
Male
Retrospective Studies
Stroke / mortality
Stroke / surgery*
Stroke / therapy*
Thrombolytic Therapy / methods*
Tissue Plasminogen Activator / administration & dosage
Tissue Plasminogen Activator / therapeutic use
Treatment Outcome

Substances

Fibrinolytic Agents
Tissue Plasminogen Activator

Grants and funding

1R01NS064592-01A1/NS/NINDS NIH HHS/United States