Aristeidis H Katsanos1,2, Konark Malhotra3, Nitin Goyal4, Adam Arthur5, Peter D Schellinger6, Martin Köhrmann7, Christos Krogias2, Guillaume Turc8,9,10,11, Georgios Magoufis12, Didier Leys13, Niaz Ahmed14,15, Pooja Khatri16, Mayank Goyal17,18, Andrei V Alexandrov4, Georgios Tsivgoulis1,4. 1. Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 2. Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany. 3. Department of Neurology, West Virginia University-Charleston Division, Charleston, WV. 4. Department of Neurology, University of Tennessee Health Science Center, Memphis, TN. 5. Department of Neurosurgery, University of Tennessee Health Science Center and Semmes-Murphey Clinic, Memphis, TN. 6. Department of Neurology and Neurogeriatry, Johannes Wesling Medical Center, Ruhr University Bochum, Minden, Germany. 7. Department of Neurology, Essen University Hospital, Essen, Germany. 8. Department of Neurology, Saint Anne Hospital, Paris, France. 9. Paris Descartes University, Paris, France. 10. National Institute of Health and Medical Research U1266, Paris, France. 11. NeuroVasc University Hospital Department, Sorbonne Paris Cité, Paris, France. 12. Metropolitan Hospital, Piraeus, Greece. 13. University of Lille, National Institute of Health and Medical Research U1171, Lille University Hospital Center, Lille, France. 14. Department of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden. 15. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. 16. University of Cincinnati, Cincinnati, OH. 17. Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada. 18. Department of Radiology, Seaman Family Magnetic Resonance Research Centre, Foothills Medical Centre, Alberta, Canada.
Abstract
OBJECTIVE: The substantial clinical improvement in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT), combined with the poor response of proximal intracranial occlusions to intravenous thrombolysis (IVT), led to questions regarding the utility of bridging therapy (BT; IVT followed by MT) compared to direct mechanical thrombectomy (dMT) for AIS patients with large vessel occlusion (LVO). METHODS: We aimed to investigate the comparative safety and efficacy of BT and dMT in AIS patients. We included all observational studies and post hoc analyses from randomized controlled clinical trials that provided data on the outcomes of AIS patients with LVO stratified by IVT treatment status prior to MT. RESULTS: We identified 38 eligible observational studies (11,798 LVO patients, mean age = 68 years, 56% treated with BT). In unadjusted analyses, BT was associated with a higher likelihood of 3-month functional independence (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.32-1.76), 3-month functional improvement (common OR [cOR] for 1-point decrease in modified Rankin Scale score = 1.52, 95% CI = 1.18-1.97), early neurological improvement (OR = 1.21, 95% CI = 1.83-1.76), successful recanalization (OR = 1.22, 95% CI = 1.02-1.46), and successful recanalization with ≤2 device passes (OR = 2.28, 95% CI = 1.43-3.64) compared to dMT. BT was also related to a lower likelihood of 3-month mortality (OR = 0.64, 95% CI = 0.57-0.73). In the adjusted analyses, BT was independently associated with a higher likelihood of 3-month functional independence (adjusted OR = 1.55, 95% CI = 1.26-1.91) and lower odds of 3-month mortality (adjusted OR = 0.80, 95% CI = 0.66-0.97) compared to dMT. The two groups did not differ in functional improvement (adjusted cOR = 1.24, 95% CI = 0.89-1.74) or symptomatic intracranial hemorrhage (adjusted OR = 0.87, 95% CI = 0.61-1.25). INTERPRETATION: BT appears to be associated with improved functional independence without evidence for safety concerns, compared to dMT, for AIS patients with LVO. ANN NEUROL 2019;86:395-406.
OBJECTIVE: The substantial clinical improvement in acute ischemic stroke (AIS) patients treated with mechanical thrombectomy (MT), combined with the poor response of proximal intracranial occlusions to intravenous thrombolysis (IVT), led to questions regarding the utility of bridging therapy (BT; IVT followed by MT) compared to direct mechanical thrombectomy (dMT) for AISpatients with large vessel occlusion (LVO). METHODS: We aimed to investigate the comparative safety and efficacy of BT and dMT in AISpatients. We included all observational studies and post hoc analyses from randomized controlled clinical trials that provided data on the outcomes of AISpatients with LVO stratified by IVT treatment status prior to MT. RESULTS: We identified 38 eligible observational studies (11,798 LVO patients, mean age = 68 years, 56% treated with BT). In unadjusted analyses, BT was associated with a higher likelihood of 3-month functional independence (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.32-1.76), 3-month functional improvement (common OR [cOR] for 1-point decrease in modified Rankin Scale score = 1.52, 95% CI = 1.18-1.97), early neurological improvement (OR = 1.21, 95% CI = 1.83-1.76), successful recanalization (OR = 1.22, 95% CI = 1.02-1.46), and successful recanalization with ≤2 device passes (OR = 2.28, 95% CI = 1.43-3.64) compared to dMT. BT was also related to a lower likelihood of 3-month mortality (OR = 0.64, 95% CI = 0.57-0.73). In the adjusted analyses, BT was independently associated with a higher likelihood of 3-month functional independence (adjusted OR = 1.55, 95% CI = 1.26-1.91) and lower odds of 3-month mortality (adjusted OR = 0.80, 95% CI = 0.66-0.97) compared to dMT. The two groups did not differ in functional improvement (adjusted cOR = 1.24, 95% CI = 0.89-1.74) or symptomatic intracranial hemorrhage (adjusted OR = 0.87, 95% CI = 0.61-1.25). INTERPRETATION:BT appears to be associated with improved functional independence without evidence for safety concerns, compared to dMT, for AISpatients with LVO. ANN NEUROL 2019;86:395-406.
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
Authors: Amrou Sarraj; James Grotta; Gregory W Albers; Ameer E Hassan; Spiros Blackburn; Arthur Day; Clark Sitton; Michael Abraham; Chunyan Cai; Mark Dannenbaum; Deep Pujara; William Hicks; Ronald Budzik; Nirav Vora; Ashish Arora; Bader Alenzi; Wondwossen G Tekle; Haris Kamal; Osman Mir; Andrew D Barreto; Maarten Lansberg; Rishi Gupta; Sheryl Martin-Schild; Sean Savitz; Georgios Tsivgoulis Journal: Neurology Date: 2021-04-19 Impact factor: 11.800
Authors: Ilko L Maier; Andreas Leha; Mostafa Badr; Ibrahim Allam; Mathias Bähr; Ala Jamous; Amelie Hesse; Marios-Nikos Psychogios; Daniel Behme; Jan Liman Journal: Front Neurol Date: 2021-06-10 Impact factor: 4.003
Authors: D Michalski; C Jungk; T Brenner; M Dietrich; C Nusshag; C J Reuß; M O Fiedler; M Bernhard; C Beynon; M A Weigand Journal: Anaesthesist Date: 2021-02 Impact factor: 1.041