Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb;7(1):22-28.
doi: 10.1136/svn-2021-001024. Epub 2021 Jul 26.

Efficacy and safety of bridging thrombolysis initiated before transfer in a drip-and-ship stroke service

Jan Christoph Purrucker  1 , Miriam Heyse  2 , Simon Nagel  2 , Christoph Gumbinger  2 , Fatih Seker  3 , Markus Möhlenbruch  3 , Peter Arthur Ringleb  2
Affiliations

Efficacy and safety of bridging thrombolysis initiated before transfer in a drip-and-ship stroke service

Jan Christoph Purrucker et al. Stroke Vasc Neurol. 2022 Feb.

Abstract

Objective: Data regarding the efficacy and safety of bridging thrombolysis (BT) initiated before transfer for evaluation of endovascular therapy is heterogeneous. We, therefore, analyse efficacy and safety of BT in patients treated within a drip-and-ship stroke service.

Methods: Consecutive adult patients suffering from acute ischaemic stroke and large-vessel occlusions (LVO) transferred to our comprehensive stroke centre for evaluation of endovascular therapy in 2017-2020 were identified from a local prospective stroke database and categorised according to BT and no-BT. BT was defined as intravenous thrombolysis initiated before transfer. LVO was assessed before and after transfer. Functional outcome before stroke and at 3 months using the modified Rankin scale (mRS) was determined. Excellent outcome was defined as mRS 0-1 or return to prestroke mRS. For safety analysis, intracranial haemorrhages and mortality at 3 months were analysed. Main analysis was limited to patients with anterior circulation stroke.

Results: Of N=714 patients, n=394 (55.2%) received BT. More patients in the BT group with documented LVO before transfer recanalised without endovascular therapy (n=46, 11.7%) than patients who did not receive BT before transfer (n=4, 1.3%, p<0.001). In multivariate analysis, BT was the strongest independent predictor of early recanalisation (adjusted OR 10.9, 95% CI 3.8 to 31.1, p<0.001). BT tended to be an independent predictor of an excellent outcome at 3 months (adjusted OR 1.38, 95% CI 0.97 to 1.96, p=0.077). There were no differences in safety between the BT and no-BT groups.

Conclusions: BT initiated before transfer was a strong independent predictor of early recanalisation.

Keywords: stroke; thrombectomy; thrombolysis.

PubMed Disclaimer

Conflict of interest statement

Competing interests: JCP has received consultation fees and travel expenses from Akcea, Bayer, Boehringer Ingelheim, Daiichi Sankyo and Pfizer. MM reports grants/grants pending from Balt, Medtronic, MicroVention, Stryker (money paid to the institution). PAR received travel support and lecture fees from Boeheringer Ingelheim, Daiichi Sankyo, Pfizer, and Bayer. SN has received consulting fees from Brainomix and Boehringer Ingelheim and lecture fees and travel expenses from Medtronic and Pfizer. CG is speaker of the commission telemedicine service of the German Stroke Society.

Figures

Figure 1
Figure 1
Flow diagram of screening process. CSC, comprehensive stroke centre; LVO, large-vessel occlusion; MCA, middle cerebral artery, PSC, primary stroke centre.
Figure 2
Figure 2
Visualisation of occlusion sites and rates of early recanalisation according to treatment with bridging thrombolysis (BT) or no-BT. BT, bridging thrombolysis; CSC, comprehensive stroke centre; ICA, internal carotid artery; MCA, middle cerebral artery; M1–M2, segments of the MCA.
See this image and copyright information in PMC

References

    1. Yang P, Zhang Y, Zhang L, et al. . Endovascular thrombectomy with or without intravenous alteplase in acute stroke. N Engl J Med 2020;382:1981–93. 10.1056/NEJMoa2001123 - DOI - PubMed
    1. Suzuki K, Matsumaru Y, Takeuchi M, et al. . Effect of mechanical thrombectomy without vs with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke: the SKIP randomized clinical trial. JAMA 2021;325:244–53. 10.1001/jama.2020.23522 - DOI - PMC - PubMed
    1. Zi W, Qiu Z, Li F, et al. . Effect of endovascular treatment alone vs intravenous alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial. JAMA 2021;325:234–43. 10.1001/jama.2020.23523 - DOI - PMC - PubMed
    1. Xiong Y, Pan Y, Nogueira RG, et al. . Treating acute large vessel occlusion stroke: to bridge or not to bridge? Stroke Vasc Neurol 2021. 10.1136/svn-2021-000952. [Epub ahead of print: 26 Apr 2021]. - DOI - PMC - PubMed
    1. Pérez de la Ossa N, Abilleira S, Jiménez X, eds. Transfer to the Local Stroke Center versus Direct Transfer to Endovascular Center of Acute Stroke Patients with Suspected Large Vessel Occlusion in the Cataln Territory (RACECAT). European Stroke Organisation Conference, 2020. - PubMed