Outcomes of Bridging Intravenous Thrombolysis Versus Endovascular Therapy Alone in Late-Window Acute Ischemic Stroke
Demeestere, Jelle ; Qureshi, Muhammad M ; Vandewalle, Lieselotte ; Wouters, Anke ; Strbian, Daniel ; Nogueira, Raul G ; Nagel, Simon ; Yamagami, Hiroshi ; Puetz, Volker ; Abdalkader, Mohamad ... show 10 more
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Qureshi, Muhammad M
Vandewalle, Lieselotte
Wouters, Anke
Strbian, Daniel
Nogueira, Raul G
Nagel, Simon
Yamagami, Hiroshi
Puetz, Volker
Abdalkader, Mohamad
Haussen, Diogo C
Mohammaden, Mahmoud H
Möhlenbruch, Markus A
Olivé-Gadea, Marta
Winzer, Simon
Ribo, Marc
Michel, Patrik
Marto, João Pedro
Tanaka, Kanta
Yoshimura, Shinichi
Martinez-Majander, Nicolas
Caparros, Francois
Henon, Hilde
Tomppo, Liisa
Dusart, Anne
Bellante, Flavio
Ramos, João Nuno
Jesser, Jessica
Sheth, Sunil A
Ortega-Gutiérrez, Santiago
Siegler, James E
Nannoni, Stefania
Kaesmacher, Johannes
Dobrocky, Tomas
Salazar-Marioni, Sergio
Farooqui, Mudassir
Virtanen, Pekka
Ventura, Rita
Zaidi, Syed F
Castonguay, Alicia C
Uchida, Kazutaka
Puri, Ajit S
Sakai, Nobuyuki
Toyoda, Kazunori
Farzin, Behzad
Masoud, Hesham E
Klein, Piers
Bui, Jenny
Rizzo, Federica
Kaiser, Daniel P O
Desfontaines, Philippe
Strambo, Davide
Cordonnier, Charlotte
Lin, Eugene
Ringleb, Peter A
Roy, Daniel
Zaidat, Osama O
Fischer, Urs
Raymond, Jean
Lemmens, Robin
Nguyen, Thanh N
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Abstract
Background: Studies comparing bridging intravenous thrombolysis (IVT) with direct endovascular therapy (EVT) in patients with acute ischemic stroke who present late are limited. We aimed to compare the clinical outcomes and safety of bridging IVT in patients with acute ischemic stroke due to anterior circulation large vessel occlusion who underwent EVT 6 to 24 hours after time last known well.
Methods: We enrolled patients with anterior circulation large vessel occlusion stroke and a National Institutes of Health Stroke Scale score of ≥6 from 20 centers across 10 countries in the multicenter retrospective CLEAR study (CT for Late Endovascular Reperfusion) between January 2014 and May 2022. We used inverse probability of treatment weighting modeling adjusted for clinical and imaging confounders to compare functional outcomes, reperfusion success, symptomatic intracranial hemorrhage, and mortality between EVT patients with and without prior IVT.
Results: Of 5098 patients screened for eligibility, we included 2749 patients, of whom 549 received bridging IVT before EVT. The timing of IVT was not recorded. Witnessed stroke onset and transfer rates were higher in the bridging IVT group (25% versus 12% and 77% versus 55%, respectively, P value for both <0.0001), and time intervals between stroke onset and treatment were shorter (time last known well-start of EVT median 560 minutes [interquartile range, 432-791] versus 724 minutes [interquartile range, 544-912]; P<0.0001). After adjustment for confounders, there was no difference in functional outcome at 3 months (adjusted common odds ratio for modified Rankin Scale shift, 1.03 [95% CI, 0.89-1.19]; P=0.72) or successful reperfusion (adjusted odds ratio, 1.19 [95% CI, 0.81-1.75]; P=0.39). There were no safety concerns associated with bridging IVT versus direct EVT (symptomatic intracranial hemorrhage: adjusted odds ratio, 0.75 [95% CI, 0.38-1.48]; P=0.40; mortality: adjusted odds ratio, 1.14 [95% CI, 0.89-1.46]; P=0.31). Results were unchanged when the analysis was limited to patients who received IVT >6 hours after last known well.
Conclusions: In patients with an anterior circulation large vessel occlusion stroke who underwent EVT 6 to 24 hours from last known well, bridging IVT was not associated with a difference in outcomes compared with direct EVT.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04096248.
Source
Demeestere J, Qureshi MM, Vandewalle L, Wouters A, Strbian D, Nogueira RG, Nagel S, Yamagami H, Puetz V, Abdalkader M, Haussen DC, Mohammaden MH, Möhlenbruch MA, Olivé-Gadea M, Winzer S, Ribo M, Michel P, Marto JP, Tanaka K, Yoshimura S, Martinez-Majander N, Caparros F, Henon H, Tomppo L, Dusart A, Bellante F, Ramos JN, Jesser J, Sheth SA, Ortega-Gutiérrez S, Siegler JE, Nannoni S, Kaesmacher J, Dobrocky T, Salazar-Marioni S, Farooqui M, Virtanen P, Ventura R, Zaidi SF, Castonguay AC, Uchida K, Puri AS, Sakai N, Toyoda K, Farzin B, Masoud HE, Klein P, Bui J, Rizzo F, Kaiser DPO, Desfontaines P, Strambo D, Cordonnier C, Lin E, Ringleb PA, Roy D, Zaidat OO, Fischer U, Raymond J, Lemmens R, Nguyen TN. Outcomes of Bridging Intravenous Thrombolysis Versus Endovascular Therapy Alone in Late-Window Acute Ischemic Stroke. Stroke. 2024 May 15. doi: 10.1161/STROKEAHA.124.046495. Epub ahead of print. PMID: 38748598.