Direct Thrombectomy versus Bridging for Patients with Emergent Large-Vessel Occlusions

Ronen R. Leker, Jose E. Cohen, David Tanne, David Orion, Gregory Telman, Guy Raphaeli, Jacob Amsalem, Jonathan Y. Streifler, Hen Hallevi, Pavel Gavriliuc, Natan M. Bornstein, Anat Horev, Nour Eddine Yaghmour

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Background and Aims: Patients with emergent large-vessel occlusion (ELVO) that present earlier than 4 h from onset are usually treated with bridging systemic thrombolysis followed by endovascular thrombectomy (EVT). Whether direct EVT (dEVT) could improve the chances of favorable outcome remains unknown. Methods: Consecutively, prospectively enrolled patients with ELVO presenting within 4 h of onset were entered into a National Acute Stroke Registry of patients undergoing revascularization. Patients treated with bridging were compared to those treated with dEVT. Excellent outcome was defined as having a modified Rankin Scale score ≤1 at 90 days following stroke. Results: Out of 392 patients that underwent thrombectomy, 270 (68%) presented within 4 h and were included. Of those, 159 (59%) underwent bridging and 111 (41%) underwent dEVT. Atrial fibrillation and congestive heart failure were more common in the dEVT group (43 vs. 30%, p = 0.04 and 20 vs. 8%, p = 0.009, respectively), but other risk factors, demographics, stroke severity and subtypes as well as baseline vessel patency state and time metrics did not differ. Excellent target vessel recanalization defined as TICI 3 (thrombolysis in cerebral infarction score) was more common in the dEVT group (75 vs. 61%, p = 0.03), but in-hospital mortality, discharge destinations, short- and long-term excellent outcome rates did not differ. On multivariate regression analysis, treatment modality did not significantly modify the chances of excellent outcome at discharge (OR 0.7; 95% CI 0.3-1.5) or at 3 months (OR 0.78 95% CI 0.4-1.4). Conclusions: The chances of attaining excellent functional outcomes are similar in ELVO patients undergoing dEVT or bridging.

Original languageEnglish
Pages (from-to)403-412
Number of pages10
JournalInterventional Neurology
Volume7
Issue number6
DOIs
StatePublished - 1 Oct 2018
Externally publishedYes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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