H Wang1,2, W Zi3, Y Hao4,5, D Yang1, Z Shi6, M Lin7, S Wang8, W Liu9, Z Wang10, X Liu1,3,4, F Guo12, Y Liu13, G Xu3, Y Xiong3, X Liu1,3,4. 1. Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, China. 2. Department of Neurology, The 89th Hospital of the People's Liberation Army, Weifang, China. 3. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China. 4. Department of Neurology, Jinling Hospital, Southern Medical University, Nanjing, China. 5. Department of Emergency Medicine, First Affiliated Hospital of Soochow University, Suzhou, China. 6. Department of Neurosurgery, The 101st Hospital of the People's Liberation Army, Wuxi, China. 7. Department of Neurology, Fuzhou General Hospital of Nanjing Military Region, Fuzhou, China. 8. Department of Neurology, The 123rd Hospital of the People's Liberation Army, Bengbu, China. 9. Department of Neurology, Wuhan No.1 Hospital, Wuhan, China. 10. Department of Neurology, Changsha Central Hospital, Changsha, China. 11. Department of Neurology, Guangdong Provincial No.2 People's Hospital, Guangzhou, China. 12. Department of Neurology, Sichuan Provincial People's Hospital, Chengdu, China. 13. Department of Medical Statistics, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
Abstract
BACKGROUND AND PURPOSE: Whether intravenous thrombolysis prior to endovascular treatment in patients with anterior circulation large-vessel occlusion (LVO) is indispensable remains unclear. The aim was to retrospectively compare, in a Chinese population, the effectiveness and safety of direct endovascular treatment (DEVT) initiated within 4.5 h after onset with bridging therapy in acute anterior circulation LVO stroke patients. METHODS: A total of 363 patients, 160 in the bridging therapy group and 203 in the DEVT group, were enrolled between 2014 and 2016. Using propensity score matching analysis, 276 patients were matched. A modified Rankin Scale score of 0-2 was considered as good functional outcome. RESULTS: Good functional outcome at 90 days in the DEVT group [40.6% (56/138)] did not significantly differ from that in the bridging group [44.9% (62/138)] (P = 0.53). Rates of symptomatic intracranial hemorrhage [13.8% (19/138) vs. 13.0% (18/138), P = 1.00] and mortality [25.4% (35/138) vs. 23.9% (33/138), P = 0.88] within 90 days were also not significantly different. Patients in the DEVT group had a lower rate of asymptomatic intracranial hemorrhage [28.3% (39/138) vs. 44.9% (62/138), P = 0.01] and a higher rate of successful reperfusion [92.0% (127/138) vs. 81.9% (113/138), P = 0.02]. CONCLUSIONS: Our results suggest that, in Chinese patients with anterior circulation LVO stroke, direct endovascular mechanical thrombectomy initiated within an intravenous thrombolysis time window carries similar effectiveness to that of bridging therapy and a decreased asymptomatic intracranial hemorrhage risk. DEVT may be an alternative for bridging therapy. Future randomized controlled trials are warranted.
BACKGROUND AND PURPOSE: Whether intravenous thrombolysis prior to endovascular treatment in patients with anterior circulation large-vessel occlusion (LVO) is indispensable remains unclear. The aim was to retrospectively compare, in a Chinese population, the effectiveness and safety of direct endovascular treatment (DEVT) initiated within 4.5 h after onset with bridging therapy in acute anterior circulation LVO strokepatients. METHODS: A total of 363 patients, 160 in the bridging therapy group and 203 in the DEVT group, were enrolled between 2014 and 2016. Using propensity score matching analysis, 276 patients were matched. A modified Rankin Scale score of 0-2 was considered as good functional outcome. RESULTS: Good functional outcome at 90 days in the DEVT group [40.6% (56/138)] did not significantly differ from that in the bridging group [44.9% (62/138)] (P = 0.53). Rates of symptomatic intracranial hemorrhage [13.8% (19/138) vs. 13.0% (18/138), P = 1.00] and mortality [25.4% (35/138) vs. 23.9% (33/138), P = 0.88] within 90 days were also not significantly different. Patients in the DEVT group had a lower rate of asymptomatic intracranial hemorrhage [28.3% (39/138) vs. 44.9% (62/138), P = 0.01] and a higher rate of successful reperfusion [92.0% (127/138) vs. 81.9% (113/138), P = 0.02]. CONCLUSIONS: Our results suggest that, in Chinese patients with anterior circulation LVO stroke, direct endovascular mechanical thrombectomy initiated within an intravenous thrombolysis time window carries similar effectiveness to that of bridging therapy and a decreased asymptomatic intracranial hemorrhage risk. DEVT may be an alternative for bridging therapy. Future randomized controlled trials are warranted.
Authors: J A Smaal; I R de Ridder; A Heshmatollah; W H van Zwam; Dwj Dippel; C B Majoie; S Brown; M Goyal; Bcv Campbell; K W Muir; A M Demchuck; A Davalos; T G Jovin; P J Mitchell; P White; J L Saver; M D Hill; Y B Roos; A van der Lugt; R J van Oostenbrugge Journal: Eur Stroke J Date: 2020-05-13
Authors: Ronen R Leker; Jose E Cohen; David Tanne; David Orion; Gregory Telman; Guy Raphaeli; Jacob Amsalem; Jonathan Y Streifler; Hen Hallevi; Pavel Gavriliuc; Natan M Bornstein; Anat Horev; Nour Eddine Yaghmour Journal: Interv Neurol Date: 2018-07-04