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. 2024 Mar;34(1):93-103.
doi: 10.1007/s00062-023-01340-9. Epub 2023 Aug 28.

Effect of Bridging Thrombolysis on the Efficacy of Stent Retriever Thrombectomy Techniques : Insights from the SWIFT-DIRECT trial

Raoul Pop  1   2   3 , Silja Räty  4 , Roberto Riva  5 , Gaultier Marnat  6 , Tomas Dobrocky  7 , Pierre Louis Alexandre  8 , Margaux Lefebvre  9 , Jean Francois Albucher  10 , Marion Boulanger  11 , Federico Di Maria  12 , Sébastien Richard  13 , Sébastien Soize  14 , Eike Immo Piechowiak  7 , Jan Liman  15   16 , Arno Reich  17 , Marc Ribo  18 , Thomas Meinel  19 , Anastasios Mpotsaris  20 , David S Liebeskind  21 , Jan Gralla  7 , Urs Fischer  22 , Johannes Kaesmacher  7 ; SWIFT DIRECT Collaborators
Affiliations

Effect of Bridging Thrombolysis on the Efficacy of Stent Retriever Thrombectomy Techniques : Insights from the SWIFT-DIRECT trial

Raoul Pop et al. Clin Neuroradiol. 2024 Mar.

Abstract

Background: There are little available data regarding the influence of intravenous thrombolysis (IVT) on the efficacy of different first line endovascular treatment (EVT) techniques.

Methods: We used the dataset of the SWIFT-DIRECT trial which randomized 408 patients to IVT + EVT or EVT alone at 48 international sites. The protocol required the use of a stent retriever (SR), but concomitant use of a balloon guide catheter (BGC) and/or distal aspiration (DA) catheter was left to the discretion of the operators. Four first line techniques were applied in the study population: SR, SR + BGC, SR + DA, SR + DA + BGC. To assess whether the effect of allocation to IVT + EVT versus EVT alone was modified by the first line technique, interaction models were fitted for predefined outcomes. The primary outcome was first pass mTICI 2c‑3 reperfusion (FPR).

Results: This study included 385 patients of whom 172 were treated with SR + DA, 121 with SR + DA + BGC, 57 with SR + BGC and 35 with SR. There was no evidence that the effect of IVT + EVT versus EVT alone would be modified by the choice of first line technique; however, allocation to IVT + EVT increased the odds of FPR by a factor of 1.68 (95% confidence interval, CI 1.11-2.54).

Conclusion: This post hoc analysis does not suggest treatment effect heterogeneity of IVT + EVT vs EVT alone in different stent retriever techniques but provides evidence for increased FPR if bridging IVT is administered before stent retriever thrombectomy.

Keywords: Endovascular treatment; First line technique; Interventional; Neurointervention; Stroke.

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