J Stroke.  2022 Jan;24(1):128-137. 10.5853/jos.2021.02082.

Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion

• Siow I
• Y.Q. Tan B
• Lee KS
• Ong N
• Toh E
• Gopinathan A
• Yang C
• Bhogal P
• Lam E
• Spooner O
• Meyer L
• Fiehler J
• Papanagiotou P
• Kastrup A
• Alexandrou M
• Zubel S
• Wu Q
• Mpotsaris A
• Maus V
• Anderson T
• Gontu V
• Arnberg F
• Lee TH
• Chan BP
• Seet RC
• Teoh HL
• Sharma VK
• Yeo LL

• KMID: 2525338
• DOI: http://doi.org/10.5853/jos.2021.02082

Abstract

Background and Purpose
Mechanical thrombectomy (MT) is an effective treatment for patients with basilar artery occlusion (BAO) acute ischemic stroke. It remains unclear whether bridging intravenous thrombolysis (IVT) prior to MT confers any benefit. This study compared the outcomes of acute BAO patients who were treated with direct MT versus combined IVT plus MT.
Methods
This multicenter retrospective cohort study included patients who were treated for acute BAO from eight comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale 0–3 measured at 90 days. Secondary outcome measures included mortality and symptomatic intracranial hemorrhage (sICH).
Results
Among 322 patients, 127 (39.4%) patients underwent bridging IVT followed by MT and 195 (60.6%) underwent direct MT. The mean±standard deviation age was 67.5±14.1 years, 64.0% were male and median National Institutes of Health Stroke Scale was 16 (interquartile range, 8 to 25). At 90-day, the rate of favorable functional outcome was similar between the bridging IVT and direct MT groups (39.4% vs. 34.4%, P=0.361). On multivariable analyses, bridging IVT was not asComorbidisociated with favorable functional outcome, mortality or sICH. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (37.2% vs. 15.5%, P=0.013).
Conclusions
Functional outcomes were similar in BAO patients treated with bridging IVT versus direct MT. In the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT may potentially confer benefit and this warrants further investigation.

Keyword

Thrombolytic therapy; Thrombectomy; Stroke; Vertebrobasilar insufficiency; Basilar artery

Figure

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  Figure 1. Ordinal shift analysis comparing 90-day modified Rankin Scale scores in patients with basilar artery occlusion acute ischemic stroke and underlying large-artery atherosclerosis who underwent bridging intravenous thrombolysis (IVT) versus direct mechanical thrombectomy (MT). OR, odds ratio; CI, confidence interval.

Reference

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