Comparative efficacy and safety of bridging strategies with direct mechanical thrombectomy in large vessel occlusion

Pan, Xiaohua; Liu, Guorong; Wu, Bo; Liu, Xiuzhen; Fang, Yong

doi:10.1097/md.0000000000014956

Cited by 19 publications

(22 citation statements)

References 36 publications

(16 reference statements)

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“…Several other studies come to similar findings when comparing patients with and without Heterozygous and homozygous G20210A-mutation, antiphospholipid syndrome, factor V Leiden mutation, protein c/s-deficiency, thrombotic thrombocytopenic purpura, paraneoplastic coagulation disorder. No significant difference in any of the subcategories IVT for recanalization success, as shown in a recent review by Pan et al [23]. It was to be expected that vascular diseases such as PAOD influence MT in a negative way.…”

Section: Discussionmentioning

confidence: 79%

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

et al. 2020

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Purpose Mechanical thrombectomy (MT) is an effective treatment for patients suffering from acute ischemic stroke. However, recanalization fails in about 16.5% of interventions. We report our experience with unsuccessful MT and analyze technical reasons plus patient-related parameters for failure. Methods Five hundred ninety-six patients with acute ischemic stroke in the anterior circulation and intention to perform MT with an aspiration catheter and/or stent retriever were analyzed. Failure was defined as 0, 1, or 2a on the mTICI scale. Patients with failing MT were analyzed for interventional progress and compared to patients with successful intervention, whereby parameters included demographics, medical history, stroke presentation, and treatment.Results One hundred of the 596 (16.8%) interventions failed. In 20 cases, thrombus could not be accessed or passed with the device. Peripheral arterial occlusive disease is common in those patients. In 80 patients, true stent retriever failure occurred. In this group, coagulation disorders are associated with poor results, whereas atrial fibrillation is associated with success.The administration of intravenous thrombolysis and intake of nitric oxide donors are associated with recanalization success. Intervention duration was significantly longer in the failing group. Conclusion In 20% of failing MT, thrombus cannot be reached/passed. Direct carotid puncture or surgical arterial access could be considered in these cases.In 80% of failing interventions, thrombus can be passed with the device, but the occluded vessel cannot be recanalized. Rescue techniques can be an option. Development of new devices and techniques is necessary to improve recanalization rates. Assessment of pre-existing illness could sensitize for occurring complications.

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Section: Discussionmentioning

confidence: 79%

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

et al. 2020

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“…Moreover, the pooled results from the RCTs demonstrated that patients eligible for IVT who received direct EVT showed no significant difference in long-term mortality, FI, recanalization rate, and incidence of sICH compared with those who underwent the bridging treatment. Some meta-analyses had also compared direct EVT and bridging treatment (35)(36)(37)(38). In comparison with patients who experienced mechanical thrombectomy (MT) only in the study by Mistry et al (37) patients receiving MT + IVT had better functional outcomes (mRS score = 0-2, summary OR = 1.27, 95% CI = 1.05-1.55, P = 0.02), lower mortality (OR = 0.71, 95% CI = 0.55-0.91, P = 0.006), and a higher rate of successful recanalization (OR = 1.46, 95% CI = 1.09-1.96, P = 0.01).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Prior Bridging Intravenous Thrombolysis With Direct Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion: Systematic Review and Meta-Analysis

Chen

Liang

et al. 2021

Front. Neurol.

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Background: Whether bridging treatment combining intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) is superior to direct EVT alone for emergent large vessel occlusion (LVO) in the anterior circulation is unknown. A systematic review and a meta-analysis were performed to investigate and assess the effect and safety of bridging treatment vs. direct EVT in patients with LVO in the anterior circulation.Methods: PubMed, EMBASE, and the Cochrane library were searched to assess the effect and safety of bridging treatment and direct EVT in LVO. Functional independence, mortality, asymptomatic and symptomatic intracranial hemorrhage (aICH and sICH, respectively), and successful recanalization were evaluated. The risk ratio and the 95% CI were analyzed.Results: Among the eight studies included, there was no significant difference in the long-term functional independence (OR = 1.008, 95% CI = 0.845–1.204, P = 0.926), mortality (OR = 1.060, 95% CI = 0.840–1.336, P = 0.624), recanalization rate (OR = 1.015, 95% CI = 0.793–1.300, P = 0.905), and the incidence of sICH (OR = 1.320, 95% CI = 0.931–1.870, P = 0.119) between bridging therapy and direct EVT. After adjusting for confounding factors, bridging therapy showed a lower recanalization rate (effect size or ES = −0.377, 95% CI = −0.684 to −0.070, P = 0.016), but there was no significant difference in the long-term functional independence (ES = 0.057, 95% CI = −0.177 to 0.291, P = 0.634), mortality (ES = 0.693, 95% CI = −0.133 to 1.519, P = 0.100), and incidence of sICH (ES = −0.051, 95% CI = −0.687 to 0.585, P = 0.875) compared with direct EVT. Meanwhile, in the subgroup analysis of RCT, no significant difference was found in the long-term functional independence (OR = 0.927, 95% CI = 0.727–1.182, P = 0.539), recanalization rate (OR = 1.331, 95% CI = 0.948–1.867, P = 0.099), mortality (OR = 1.072, 95% CI = 0.776–1.481, P = 0.673), and sICH incidence (OR = 1.383, 95% CI = 0.806–2.374, P = 0.977) between patients receiving bridging therapy and those receiving direct DVT.Conclusion: For stroke patients with acute anterior circulation occlusion and who are eligible for intravenous thrombolysis, there is no significant difference in the clinical effect between direct EVT and bridging therapy, which needs to be verified by more randomized controlled trials.

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“…Currently, the advantage of bridging therapy versus non-bridging is controversially discussed [26][27][28][29]. Recent studies indicate a possible benefit of bridging therapy in terms of recanalization rate and functional outcome, with no significant increase in the rate of intracranial hemorrhage in the bridging group [30,31]. An analysis of data from the Virtual International Stroke Trials Archive (VISTA) study suggests that stroke patients may benefit from rtPA treatment in terms of cognition [32].…”

Section: Introductionmentioning

confidence: 99%

Bridging therapy is associated with improved cognitive function after large vessel occlusion stroke – an analysis of the German Stroke Registry

Ettelt¹,

Maier²,

Schnieder³

et al. 2020

Neurol. Res. Pract.

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Background: The targeted use of endovascular therapy (EVT), with or without intravenous thrombolysis (IVT) in acute large cerebral vessel occlusion stroke (LVOS) has been proven to be superior compared to IVT alone. Despite favorable functional outcome, many patients complain about cognitive decline after EVT. If IVT in addition to EVT has positive effects on cognitive function is unclear. Methods: We analyzed data from the German Stroke Registry (GSR, an open, multicenter and prospective observational study) and compared cognitive function 90 days after index ischemic stroke using MoCA in patients with independent (mRS ≤ 2 pts) and excellent (mRS = 0 pts) functional outcome receiving combined EVT and IVT (EVT + IVT) vs. EVT alone (EVT-IVT). Results: Of the 2636 GSR patients, we included 166 patients with mRS ≤ 2 at 90 days in our analysis. Of these, 103 patients (62%) received EVT + IVT, 63 patients (38%) were treated with EVT alone. There was no difference in reperfusion status between groups (mTICI ≥ 2b in both groups at 95%, p = 0.65). Median MoCA score in the EVT + IVT group was 20 pts. (18-25 IQR) vs. 18 pts. (16-21 IQR) in the EVT-IVT group (p = 0.014). There were more patients with cognitive impairment (defined as MoCA < 26 pts) in the EVT-IVT group (54 patients (86%)) compared to the EVT + IVT group (78 patients (76%)). EVT + IVT was associated with a higher MoCA score at 90 days (mRS ≤ 2: p = 0.033, B = 2.39; mRS = 0: p = 0.021, B = 4.38). Conclusions: In Patients with good functional outcome after LVOS, rates of cognitive impairment are lower with combined EVT and IVT compared to EVT alone.

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Comparative efficacy and safety of bridging strategies with direct mechanical thrombectomy in large vessel occlusion

Cited by 19 publications

References 36 publications

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

Why we fail: mechanisms and co-factors of unsuccessful thrombectomy in acute ischemic stroke

Comparison of Prior Bridging Intravenous Thrombolysis With Direct Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion: Systematic Review and Meta-Analysis

Bridging therapy is associated with improved cognitive function after large vessel occlusion stroke – an analysis of the German Stroke Registry

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