Is bridging therapy still required in stroke due to carotid artery terminus occlusions?

Autor:	Bourcier R; Department of Neuroradiology, University Hospital of Nantes, Nantes, France., Alexandre PL; Department of Neuroradiology, University Hospital of Nantes, Nantes, France., Eugène F; Department of Neuroradiology, University Hospital of Rennes, Rennes, France., Delasalle-Guyomarch B; Centre d'investigation clinique Thorax, l'Institut du Thorax, University Hospital of Nantes, Nantes, France., Guillon B; Stroke Unit, University Hospital of Nantes, Nantes, France., Kerleroux B; University Hospital of Tours, Tours, France., Saleme S; Interventional Neuroradiology, CHU Limoges, Limoges, France., Marnat G; Interventional and Diagnostic Neuroradiology, Bordeaux University Hospital, Bordeaux, France., Boucebci S; Department of Neuroradiology, University Hospital of Poitiers, Poitiers, France., Mirza M; Neuravi Ltd, Galway, Ireland., Ferré JC; Department of Neuroradiology, University Hospital of Rennes, Rennes, France., Papagiannaki C; Interventional Neuroradiology, CHU Rouen, Rouen, France., Desal H; Department of Neuroradiology, University Hospital of Nantes, Nantes, France.
Jazyk:	angličtina
Zdroj:	Journal of neurointerventional surgery [J Neurointerv Surg] 2018 Jul; Vol. 10 (7), pp. 625-628. Date of Electronic Publication: 2017 Nov 16.
DOI:	10.1136/neurintsurg-2017-013398
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
Databáze:	MEDLINE
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