Bridge mechanical thrombectomy may be a better choice for acute large vessel occlusions
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Bridge mechanical thrombectomy may be a better choice for acute large vessel occlusions Mingming Zha1 · Kangmo Huang2 · Dong Yang2 · Lulu Xiao2 · Haodi Cai1 · Qingwen Yang1 · Rui Liu2 · Xinfeng Liu1,2 Accepted: 5 October 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Direct mechanical thrombectomy (DMT) was confirmed non-inferior to bridge mechanical thrombectomy (BMT, MT preceded by intravenous alteplase within 4.5 h after symptom onset) for acute ischemic stroke with large vessel occlusions (AIS-LVO) in mothership patients. However, the noninferiority of DMT in the general population (including drip and ship mode) is controversial, and the impact of thrombolysis on retrieval attempts remains uncertain. This was a post-hoc analysis of a multi-center, prospective enrolled study. Patients were divided into the BMT group and the DMT group. Baseline characteristics and clinical outcomes were compared by using univariate analysis, multivariable analysis, and propensity score matching analysis, respectively. Of all 245 patients enrolled in this study, 79 (32.2%) patients underwent BMT. In the multivariable analysis, the ratio of excellent prognosis (defined as modified Rankin Scale [mRS] score 0–1 at 90 days) was significantly higher in the BMT group compared with the DMT group (odds ratio, 2.731; 95% confidence interval, 1.238–6.023; P = 0.013). The ratio of good prognosis (mRS score 0–2 at 90 days), successful recanalization rate [modified Thrombolysis In Cerebral Ischemia (mTICI) score 2b-3] and mortality rate were similar between the two groups. The excellent prognosis rate was significantly higher in the BMT group after propensity score matching (P = 0.023). BMT was associated with a higher ratio of excellent prognosis (mRS 0–1) and a similar successful recanalization rate without increasing peri-operation complications compared with DMT in AIS-LVO patients. It is prudent to continue BMT until further data is available.
Mingming Zha and Kangmo Huang contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11239-020-02307-0) contains supplementary material, which is available to authorized users. * Rui Liu [email protected] * Xinfeng Liu [email protected] 1
Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China
Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Xuanwu District, No. 305 Zhongshan East Road, Nanjing 210002, Jiangsu, China
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Graphic abstract
Keywords Acute ischemic stroke · Intravenous thrombolysis · Mechanical thrombectomy · Prognosis
Highlights • Noninferiority of direct mechanical thrombectomy com-
pared with bridge mechanical thrombectomy in the general population is controversial. • Ratio of excellent prognosis was significantly higher when treated by bridge mechanical thrombectomy. • Multi-center data acquisition and representativeness of cont
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