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

Pop, Raoul; Räty, Silja; Riva, Roberto; Marnat, Gaultier; Dobrocky, Tomas; Alexandre, Pierre Louis; Lefebvre, Margaux; Albucher, Jean Francois; Boulanger, Marion; Di Maria, Federico; Richard, Sébastien; Soize, Sébastien; Piechowiak, Eike Immo; Liman, Jan; Reich, Arno; Ribo, Marc; Meinel, Thomas; Mpotsaris, Anastasios; Liebeskind, David S; Gralla, Jan; ... (2024). Effect of Bridging Thrombolysis on the Efficacy of Stent Retriever Thrombectomy Techniques : Insights from the SWIFT-DIRECT trial. Clinical neuroradiology, 34(1), pp. 93-103. Springer-Verlag 10.1007/s00062-023-01340-9

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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.

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