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Several national and international professional organizations recommend the use of intravenous thrombolysis (IVT) in patients with ischemic stroke within 1-3 hours of symptom onset .
Previous randomized controlled trials (RCTs) have confirmed the good efficacy and safety of mechanical thrombectomy (MT) in the treatment of patients with anterior circulation stroke caused by large vessel occlusion (LVO) .
For patients eligible for both treatments, current guidelines recommend IVT followed by MT (aka bridging therapy [BT]) .
IVT has limited efficacy in achieving LVO recanalization, and it has been reported that IVT may delay MT initiation, lead to thrombus fragmentation and distal migration, and increase the risk of symptomatic hemorrhage (SICH)
.
Therefore, several groups have investigated the efficacy and safety of BT versus MT alone in patients with LVO
Several national and international professional organizations recommend the use of intravenous thrombolysis (IVT) in patients with ischemic stroke within 1-3 hours of symptom onset .
Previous randomised controlled trials (RCTs) have confirmed the good efficacy and safety of mechanical thrombectomy (MT) in the treatment of patients with anterior circulation stroke caused by large vessel occlusion (LVO) .
For patients eligible for both treatments, current guidelines recommend IVT followed by MT (aka bridging therapy [BT]) .
Stroke Intravenous Thrombolysis (IVT) Randomized Controlled Trial (RCT) Mechanical Thrombectomy (MT) Large Vessel Occlusion (LVO) Vascular Guidelines MT (aka Bridging Therapy [BT]) Symptomatic Thrombosis Hemorrhage (SICH) Study Design
Three new RCTs were recently published comparing LVO patients treated with BT and MT
.
A meta-analysis of these three studies showed comparable functional independence and mortality between the two treatments, but IVT before thrombectomy (BT) was more likely to lead to successful recanalization compared with patients who received MT alone
Thrombectomy (BT) The efficacy and safety of BT and MT were compared by pooling data from all observational and randomized studies conducted to date in patients with anterior circulation LVO stroke
A systematic search of the biomedical literature database from October 29, 2021 to October 29, 2021 to identify prospective and retrospective studies comparing functional independence (modified Rankin score 0–2 points) and 90-day mortality, symptomatic bleeding (SICH), and success rates
.
Effect sizes were expressed as odds ratios (ORs) and analyzed with a random-effects meta-analysis
statistics
- In total, 41 studies involving 14,885 patients were included
.
The mean ± SD was 69 ± 11 years in the BT group and 70 ± 11 years in the MT group
Functional independence, odds of successful reperfusion and mortality across the dataset favored the use of BT over MT (moderate heterogeneity and low-quality evidence)
Trifan G, Biller J, Testai FD.
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