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. 2018 Oct;7(6):403-412.
doi: 10.1159/000489575. Epub 2018 Jul 4.

Direct Thrombectomy versus Bridging for Patients with Emergent Large-Vessel Occlusions

Ronen R Leker  1 , Jose E Cohen  2 , David Tanne  3 , David Orion  3 , Gregory Telman  4 , Guy Raphaeli  5 , Jacob Amsalem  4 , Jonathan Y Streifler  5 , Hen Hallevi  6 , Pavel Gavriliuc  1 , Natan M Bornstein  6 , Anat Horev  7 , Nour Eddine Yaghmour  1
Affiliations

Direct Thrombectomy versus Bridging for Patients with Emergent Large-Vessel Occlusions

Ronen R Leker et al. Interv Neurol. 2018 Oct.

Abstract

Background and aims: Patients with emergent large-vessel occlusion (ELVO) that present earlier than 4 h from onset are usually treated with bridging systemic thrombolysis followed by endovascular thrombectomy (EVT). Whether direct EVT (dEVT) could improve the chances of favorable outcome remains unknown.

Methods: Consecutively, prospectively enrolled patients with ELVO presenting within 4 h of onset were entered into a National Acute Stroke Registry of patients undergoing revascularization. Patients treated with bridging were compared to those treated with dEVT. Excellent outcome was defined as having a modified Rankin Scale score ≤1 at 90 days following stroke.

Results: Out of 392 patients that underwent thrombectomy, 270 (68%) presented within 4 h and were included. Of those, 159 (59%) underwent bridging and 111 (41%) underwent dEVT. Atrial fibrillation and congestive heart failure were more common in the dEVT group (43 vs. 30%, p = 0.04 and 20 vs. 8%, p = 0.009, respectively), but other risk factors, demographics, stroke severity and subtypes as well as baseline vessel patency state and time metrics did not differ. Excellent target vessel recanalization defined as TICI 3 (thrombolysis in cerebral infarction score) was more common in the dEVT group (75 vs. 61%, p = 0.03), but in-hospital mortality, discharge destinations, short- and long-term excellent outcome rates did not differ. On multivariate regression analysis, treatment modality did not significantly modify the chances of excellent outcome at discharge (OR 0.7; 95% CI 0.3-1.5) or at 3 months (OR 0.78 95% CI 0.4-1.4).

Conclusions: The chances of attaining excellent functional outcomes are similar in ELVO patients undergoing dEVT or bridging.

Keywords: Endovascular treatment; Reperfusion; Stentriever; Stroke; Thrombolysis.

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Figures

Fig. 1.
Fig. 1.
Distribution of patients treated with EVT in the NASIS-REVASC.
Fig. 2.
Fig. 2.
Distributions of different mRS categories in patients treated with bridging or dEVT in the NASIS-REVASC.
Fig. 3.
Fig. 3.
Odds ratios for factors included in the multivariate analyses for mRS scores 0–1 at 3 months following stroke (a), in-hospital mortality (b), favorable target vessel recanalization (TICI 3) at the end of EVT (c), and major early recovery defined as an 8-point drop in NIHSS or NIHSS 0–1 on day 1 following procedure (d).
See this image and copyright information in PMC

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