BACKGROUND AND PURPOSE: Randomized controlled trials have shown that bridging endovascular therapy (EVT) after intravenous thrombolysis (IVT) therapy improves outcome in patients with stroke with large-artery anterior circulation stroke compared with IVT alone. It remains unknown whether IVT adds any benefit to EVT in these patients. The aim of this study was to assess recanalization rates and thrombus dislocation before initiation of EVT in patients receiving bridging therapy. METHODS: All patients in the Bernese stroke registry (2008-2015) in whom bridging therapy was considered were included in this analysis. Relevant recanalization before EVT, thrombus dislocation and increase in thrombus load between initial and control imaging were assessed retrospectively. RESULTS: A total of 319 patients were included. Relevant recanalization before EVT occurred in 8.8% and thrombus dislocation in 7.2% of patients before EVT. Recanalization rates were significantly higher in distal compared with large and more proximal vessel occlusions of the anterior circulation (occlusion of internal carotid artery, 5.4%; middle cerebral artery segment M1, 8.1%; middle cerebral artery segment M2, 17.6%) and in drip-and-ship patients compared with mother-ship patients. In multivariable regression analysis the occlusion site was the only independent predictor of relevant recanalization before EVT (P = 0.046). CONCLUSIONS: Relevant recanalization after IVT and prior to EVT in patients receiving bridging therapy was highly dependent on the occlusion site. These findings suggest that future randomized controlled trials should consider occlusion site and treatment paradigm to specify patients who benefit most from bridging therapy in comparison to EVT or IVT alone.
BACKGROUND AND PURPOSE: Randomized controlled trials have shown that bridging endovascular therapy (EVT) after intravenous thrombolysis (IVT) therapy improves outcome in patients with stroke with large-artery anterior circulation stroke compared with IVT alone. It remains unknown whether IVT adds any benefit to EVT in these patients. The aim of this study was to assess recanalization rates and thrombus dislocation before initiation of EVT in patients receiving bridging therapy. METHODS: All patients in the Bernese stroke registry (2008-2015) in whom bridging therapy was considered were included in this analysis. Relevant recanalization before EVT, thrombus dislocation and increase in thrombus load between initial and control imaging were assessed retrospectively. RESULTS: A total of 319 patients were included. Relevant recanalization before EVT occurred in 8.8% and thrombus dislocation in 7.2% of patients before EVT. Recanalization rates were significantly higher in distal compared with large and more proximal vessel occlusions of the anterior circulation (occlusion of internal carotid artery, 5.4%; middle cerebral artery segment M1, 8.1%; middle cerebral artery segment M2, 17.6%) and in drip-and-ship patients compared with mother-ship patients. In multivariable regression analysis the occlusion site was the only independent predictor of relevant recanalization before EVT (P = 0.046). CONCLUSIONS: Relevant recanalization after IVT and prior to EVT in patients receiving bridging therapy was highly dependent on the occlusion site. These findings suggest that future randomized controlled trials should consider occlusion site and treatment paradigm to specify patients who benefit most from bridging therapy in comparison to EVT or IVT alone.
Authors: Guillaume Turc; Georgios Tsivgoulis; Heinrich J Audebert; Hieronymus Boogaarts; Pervinder Bhogal; Gian Marco De Marchis; Ana Catarina Fonseca; Pooja Khatri; Mikaël Mazighi; Natalia Pérez de la Ossa; Peter D Schellinger; Daniel Strbian; Danilo Toni; Philip White; William Whiteley; Andrea Zini; Wim van Zwam; Jens Fiehler Journal: Eur Stroke J Date: 2022-02-17
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Authors: Heitor C Alves; Kilian M Treurniet; Ivo G H Jansen; Albert J Yoo; Bruna G Dutra; Guang Zhang; Lonneke Yo; Adriaan C G M van Es; Bart J Emmer; René van den Berg; Ido R van den Wijngaard; Geert J Lycklama À Nijeholt; Jan-Albert Vos; Yvo B W E M Roos; Wouter Schonewille; Henk A Marquering; Charles B L M Majoie Journal: Stroke Date: 2019-10-10 Impact factor: 7.914
Authors: Toby I Gropen; Nataliya V Ivankova; Mark Beasley; Erik P Hess; Brian Mittman; Melissa Gazi; Michael Minor; William Crawford; Alice B Floyd; Gary L Varner; Michael J Lyerly; Camella C Shoemaker; Jackie Owens; Kent Wilson; Jamie Gray; Shaila Kamal Journal: Front Neurol Date: 2021-12-06 Impact factor: 4.003
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Authors: Manon Kappelhof; Manon L Tolhuisen; Kilian M Treurniet; Bruna G Dutra; Heitor Alves; Guang Zhang; Scott Brown; Keith W Muir; Antoni Dávalos; Yvo B W E M Roos; Jeffrey L Saver; Andrew M Demchuk; Tudor G Jovin; Serge Bracard; Bruce C V Campbell; Aad van der Lugt; Francis Guillemin; Philip White; Michael D Hill; Diederik W J Dippel; Peter J Mitchell; Mayank Goyal; Henk A Marquering; Charles B L M Majoie Journal: Stroke Date: 2021-07-20 Impact factor: 7.914