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Strokes in the anterior circulation: comparison between bridging and intravenous thrombolysis
Author(s) -
Sztajzel R. F.,
Muller H.,
Sekoranja L.,
Viaccoz A.,
Mendez Pereira V.,
Narata A. P.,
Lovblad K.,
Altrichter S.,
Michel P.
Publication year - 2015
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/ane.12338
Subject(s) - thrombolysis , bridging (networking) , circulation (fluid dynamics) , medicine , cardiology , anesthesia , computer science , mechanics , myocardial infarction , computer security , physics
Background and purpose To compare safety and efficacy of bridging approach with intravenous ( IV ) thrombolysis in patients with acute anterior strokes and proximal occlusions. Patients and methods Consecutive patients with ischemic anterior strokes admitted within a 4 h 30 min window in two different centers were included. The first center performed IV therapy (alteplase 0.6 mg/kg) during 30 min and, in absence of clinical improvement, mechanical thrombectomy with flow restoration using a Solitaire stent (StS); the second carried out IV thrombolysis (alteplase 0.9 mg/kg) alone. Only T, M1 or M2 occlusions present on CT angiography were considered. Endpoints were clinical outcome and mortality at 3 months. Results There were 63 patients in the bridging and 163 in the IV group. No significant differences regarding baseline characteristics were observed. At 3 months, 46% ( n = 29) of the patients treated in the combined and 23% ( n = 38) of those treated in the IV group had a modified Rankin scale ( mRS ) of 0–1 ( P < 0.001). A statistical significant difference was observed for all sites of occlusion. In a logistic regression model, National Institute of Health Stroke Scale (NIHSS) and bridging therapy were independent predictors of good outcome (respectively, P = 0.001 and P = 0.0018). Symptomatic hemorrhage was documented in 6.3% vs 3.7% in the bridging and in the IV group, respectively ( P = 0.32). There was no difference in mortality. Conclusions Our results suggest that patients treated with a bridging approach were more likely to have minimal or no deficit at all at 3 months as compared to the IV treated group.