Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke: A Matched-Pairs Analysis.

Broeg-Morvay, Anne; Mordasini, Pasquale; Bernasconi, Corrado Angelo; Bühlmann, Monika; Pult, Frauke; Arnold, Marcel; Schroth, Gerhard; Jung, Simon; Mattle, Heinrich; Gralla, Jan; Fischer, Urs (2016). Direct Mechanical Intervention Versus Combined Intravenous and Mechanical Intervention in Large Artery Anterior Circulation Stroke: A Matched-Pairs Analysis. Stroke, 47(4), pp. 1037-1044. Lippincott Williams & Wilkins 10.1161/STROKEAHA.115.011134

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BACKGROUND AND PURPOSE Five randomized controlled trials have consistently shown that mechanical thrombectomy (MT) in addition to best medical treatment (±intravenous tissue-type plasminogen activator) improves outcome after acute ischemic stroke in patients with large artery anterior circulation stroke. Whether direct MT is equally effective as combined intravenous thrombolysis with MT (ie, bridging thrombolysis) remains unclear. METHODS We retrospectively compared clinical and radiological outcomes in 167 bridging patients with 255 patients receiving direct MT because of large artery anterior circulation stroke. We matched all patients from the direct MT group who would have qualified for intravenous tissue-type plasminogen activator with controls from the bridging group, using multivariate and propensity score analyses. Functional independence was defined as modified Rankin Scale score of 0 to 2. RESULTS From February 2009 to August 2014, 40 patients from the direct MT group would have qualified for bridging thrombolysis but were treated with MT only. Clinical and radiological characteristics did not differ from the bridging cohort, except for higher rates of hypercholesterolemia (P=0.019), coronary heart disease (P=0.039), and shorter intervals from symptom onset to endovascular intervention (P=0.01) in the direct MT group. Functional independence, mortality, and intracerebral hemorrhage rates did not differ (P>0.1). After multivariate matching analysis outcome in both groups did not differ, except for lower rates of asymptomatic intracerebral hemorrhage (P=0.023) and lower mortality (P=0.007) in the direct MT group. CONCLUSIONS In patients with large anterior circulation stroke, direct mechanical intervention seems to be equally effective as bridging thrombolysis. A randomized trial comparing direct MT with bridging therapy is warranted.

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:

Broeg-Morvay, Anne; Mordasini, Pasquale; Bernasconi, Corrado Angelo; Bühlmann, Monika; Arnold, Marcel; Schroth, Gerhard; Jung, Simon; Mattle, Heinrich; Gralla, Jan and Fischer, Urs

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0039-2499

Publisher:

Lippincott Williams & Wilkins

Language:

English

Submitter:

Martin Zbinden

Date Deposited:

08 Jun 2016 14:21

Last Modified:

08 Jun 2016 14:21

Publisher DOI:

10.1161/STROKEAHA.115.011134

PubMed ID:

26906917

Uncontrolled Keywords:

bridging thrombolysis; ischemic stroke; mechanical thrombolysis; thrombectomy; tissue-type plasminogen activator

BORIS DOI:

10.7892/boris.81246

URI:

https://boris.unibe.ch/id/eprint/81246

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