Strokes in the anterior circulation: comparison between bridging and intravenous thrombolysis. (27th October 2014)

• Record Type: Journal Article
• Authors: Sztajzel, R. F.; Muller, H.; Sekoranja, L.; Viaccoz, A.; Mendez Pereira, V.; Narata, A. P.; Lovblad, K.; Altrichter, S.; Michel, P.
• Is Part Of: Acta neurologica Scandinavica. Volume 131:Number 5(2015:May)
• Page Start: 329
• Page End: 335
• Publication Date: 2014-10-27
• Subjects: Neurology -- Periodicals; 616.8
• DOI: 10.1111/ane.12338
• Languages: English
• ISSNs: 0001-6314

Abstract

<abstract abstract-type="main" id="ane12338-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="ane12338-sec-0001" sec-type="section"> <title>Background and purpose</title> <p>To compare safety and efficacy of bridging approach with intravenous (IV) thrombolysis in patients with acute anterior strokes and proximal occlusions.</p> </sec> <sec id="ane12338-sec-0002" sec-type="section"> <title>Patients and methods</title> <p>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.</p> </sec> <sec id="ane12338-sec-0003" sec-type="section"> <title>Results</title> <p>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% (<italic>n</italic> = 29) of the patients treated in the combined and 23% (<italic>n</italic> = 38) of those treated in the IV group had a modified Rankin scale (mRS) of 0–1 (<italic>P </italic><<italic> </italic>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, <italic>P</italic> = 0.001 and <italic>P</italic> = 0.0018). Symptomatic hemorrhage was documented in 6.3% vs 3.7% in the bridging and in the IV group, respectively (<italic>P</italic> = 0.32). There was no difference in mortality.</p> </sec> <sec id="ane12338-sec-0004" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>