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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. 1 Department of Neuroradiology, University Hospital of Nantes, Nantes, France
  2. 2 Department of Neuroradiology, University Hospital of Rennes, Rennes, France
  3. 3 Centre d’investigation clinique Thorax, l’Institut du Thorax, University Hospital of Nantes, Nantes, France
  4. 4 Stroke Unit, University Hospital of Nantes, Nantes, France
  5. 5 University Hospital of Tours, Tours, France
  6. 6 Interventional Neuroradiology, CHU Limoges, Limoges, France
  7. 7 Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France
  8. 8 Department of Neuroradiology, University Hospital of Poitiers, Poitiers, France
  9. 9 Neuravi Ltd, Galway, Ireland
  10. 10 Interventional Neuroradiology, CHU Rouen, Rouen, France
  1. Correspondence to Dr Romain Bourcier, Department of Neuroradiology, University Hospital of Nantes, Nantes 44, France; Romain.BOURCIER{at}


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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  • 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.