Impact of intravenous thrombolysis on recanalization rates in patients with stroke treated with bridging therapy.

Mueller, L; Pult, Frauke; Meisterernst, Julia Anne; Heldner, Mirjam Rachel; Mono, Marie-Luise; Kurmann, Rebekka; Bühlmann, Monika; Fischer, Urs; Mattle, Heinrich; Arnold, Marcel; Mordasini, Pasquale; Gralla, Jan; Schroth, Gerhard; El-Koussy, Marwan; Jung, Simon (2017). Impact of intravenous thrombolysis on recanalization rates in patients with stroke treated with bridging therapy. European journal of neurology, 24(8), pp. 1016-1021. Wiley-Blackwell 10.1111/ene.13330

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BACKGROUND AND PURPOSE Randomized controlled trials have shown that bridging endovascular therapy (EVT) after intravenous thrombolysis (IVT) therapy improves outcome in patients with stroke with large-artery anterior circulation stroke compared with IVT alone. It remains unknown whether IVT adds any benefit to EVT in these patients. The aim of this study was to assess recanalization rates and thrombus dislocation before initiation of EVT in patients receiving bridging therapy. METHODS All patients in the Bernese stroke registry (2008-2015) in whom bridging therapy was considered were included in this analysis. Relevant recanalization before EVT, thrombus dislocation and increase in thrombus load between initial and control imaging were assessed retrospectively. RESULTS A total of 319 patients were included. Relevant recanalization before EVT occurred in 8.8% and thrombus dislocation in 7.2% of patients before EVT. Recanalization rates were significantly higher in distal compared with large and more proximal vessel occlusions of the anterior circulation (occlusion of internal carotid artery, 5.4%; middle cerebral artery segment M1, 8.1%; middle cerebral artery segment M2, 17.6%) and in drip-and-ship patients compared with mother-ship patients. In multivariable regression analysis the occlusion site was the only independent predictor of relevant recanalization before EVT (P = 0.046). CONCLUSIONS Relevant recanalization after IVT and prior to EVT in patients receiving bridging therapy was highly dependent on the occlusion site. These findings suggest that future randomized controlled trials should consider occlusion site and treatment paradigm to specify patients who benefit most from bridging therapy in comparison to EVT or IVT alone.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology
04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Institute of Diagnostic and Interventional Neuroradiology

UniBE Contributor:

Pult, Frauke; Meisterernst, Julia Anne; Heldner, Mirjam Rachel; Mono, Marie-Luise; Kurmann, Rebekka; Bühlmann, Monika; Fischer, Urs; Mattle, Heinrich; Arnold, Marcel; Mordasini, Pasquale; Gralla, Jan; Schroth, Gerhard; El-Koussy, Marwan and Jung, Simon

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1351-5101

Publisher:

Wiley-Blackwell

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

07 Aug 2017 09:09

Last Modified:

16 Jul 2018 14:26

Publisher DOI:

10.1111/ene.13330

PubMed ID:

28649759

Uncontrolled Keywords:

acute stroke; bridging; early recanalization; endovascular therapy; intravenous thrombolysis

BORIS DOI:

10.7892/boris.101636

URI:

https://boris.unibe.ch/id/eprint/101636

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