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Original research
Is bridging therapy still required in stroke due to carotid artery terminus occlusions?
  1. Romain Bourcier1,
  2. Pierre-Louis Alexandre1,
  3. François Eugène2,
  4. Béatrice Delasalle-Guyomarch3,
  5. Benoit Guillon4,
  6. Basile Kerleroux5,
  7. Suzana Saleme6,
  8. Gaultier Marnat7,
  9. Samy Boucebci8,
  10. Mahmood Mirza9,
  11. Jean-Christophe Ferré2,
  12. Chrysanthi Papagiannaki10,
  13. Hubert Desal1
  1. 1Department of Neuroradiology, University Hospital of Nantes, Nantes, France
  2. 2Department of Neuroradiology, University Hospital of Rennes, Rennes, France
  3. 3Centre d’investigation clinique Thorax, l’Institut du Thorax, University Hospital of Nantes, Nantes, France
  4. 4Stroke Unit, University Hospital of Nantes, Nantes, France
  5. 5University Hospital of Tours, Tours, France
  6. 6Interventional Neuroradiology, CHU Limoges, Limoges, France
  7. 7Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
  8. 8Department of Neuroradiology, University Hospital of Poitiers, Poitiers, France
  9. 9Neuravi Ltd, Galway, Ireland
  10. 10Interventional Neuroradiology, CHU Rouen, Rouen, France
  1. Correspondence to Dr Romain Bourcier, Department of Neuroradiology, University Hospital of Nantes, Nantes 44, France; Romain.BOURCIER{at}chu-nantes.fr

Abstract

Introduction Studies comparing endovascular stroke treatment using mechanical thrombectomy (MT) with or without prior IV tissue plasminogen activator (tPa) have included only 30% of internal carotid artery terminus occlusions (ICA-O), a known predictor of recanalization failure with IV tPa.

Objective To carry out a retrospective multicenter analysis of prospectively collected data of consecutive patients to investigate the impact of intravenous thrombolysis on ICA-O by comparing patients treated with MT alone or bridging therapy (BT).

Material and methods Patients with ICA-O treated with MT alone or BT were retrospectively examined and compared. Demographic data, vascular risk factors, treatment modalities, complications, technical and clinical outcomes were recorded. A propensity score (PS) analysis was used to compare modified Rankin Scale (mRS) score at 3 months and intracerebral hemorrhage (ICH) between groups.

Results 141 consecutive patients (60% BT/40% MT) were included between January 2014 and June 2016. Baseline characteristics did not differ between the groups. There was no significant difference in the rate of Thrombolysis in Cerebral Infarction 2b/3, distal emboli, and median number of passes between the groups. There was a significant difference between BT and MT groups in the median time between imaging and groin puncture (median 97 min vs 75, p=0.007), the rate of ICH (44% vs 27%, p=0.05), but not for symptomatic ICH (18% vs 13%, p=0.49). With PS, there was a trend towards a higher rate of ICH (OR=2.3, 95% CI 0.9 to 5.9, p=0.09) in the BT group compared with the MT alone group, with no difference in mRS score ≤2 at 3 months (OR=1.6, 95% CI 0.7 to 3.7, p=0.29).

Conclusion There was no significant difference in clinical outcomes between patients receiving bridging therapy versus direct thrombectomy. Bridging therapy delayed time to groin puncture and increased ICH rate.

  • stroke
  • thrombolysis
  • thrombectomy
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Footnotes

  • CP and HD contributed equally.

  • Contributors RB conceived the idea for the study, collected data, and wrote the manuscript. P-LA collected data and wrote the manuscript. GM, FE, BK, SB, SS collected data. BG, HD critically reviewed the manuscript. BD-G performed the statistical analysis. MM critically reviewed the manuscript and corrected the spelling and grammar.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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