Safety and efficacy of bridging intravenous thrombolysis plus mechanical thrombectomy versus direct mechanical thrombectomy in different age groups of acute ischemic stroke patients.

Autor: Marrama F; Comprehensive Stroke Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy., Mascolo AP; Comprehensive Stroke Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy. alfredopaolo.mascolo@gmail.com., Sallustio F; Comprehensive Stroke Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy.; Neurovascular Unit, Emergency Department, Ospedale dei Castelli, Rome, Italy., Bovino M; Comprehensive Stroke Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy.; Department of Neurology, University of Chicago, Chicago, USA., Rocco A; Comprehensive Stroke Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy., D'Agostino F; Comprehensive Stroke Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy., Ros VD; Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy., Morosetti D; Interventional Radiology Unit, Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy., Mori F; Comprehensive Stroke Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy., Lacidogna G; Comprehensive Stroke Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy., Maestrini I; Comprehensive Stroke Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy., Alemseged F; Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia., Panetta V; L'altrastatistica srl - Consultancy & Training- Biostatistics office, Rome, Italy., Diomedi M; Comprehensive Stroke Center, Department of Systems Medicine, University of Rome Tor Vergata, Rome, 00133, Italy.
Jazyk: angličtina
Zdroj: Acta neurologica Belgica [Acta Neurol Belg] 2024 Oct 22. Date of Electronic Publication: 2024 Oct 22.
DOI: 10.1007/s13760-024-02672-0
Abstrakt: Objective: To evaluate the safety and efficacy of bridging intravenous thrombolysis plus mechanical thrombectomy (MT) versus direct MT in different age groups of patients with acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO) of the anterior circulation.
Methods: Consecutive patients from the prospective endovascular stroke registry of the Comprehensive Stroke Center, University of Rome Tor Vergata, Italy, between January 2015 and June 2021 were retrospectively analyzed. Patients were divided into age groups (≤ 80 years old and > 80 years old); for each age group, they were further divided in the bridging therapy group and the direct MT group. We performed a propensity score analysis according to baseline characteristics. Safety outcomes were any intracerebral hemorrhage (ICH), symptomatic ICH (sICH) and 3-month mortality. Efficacy outcomes were successful recanalization (modified Thrombolysis in Cerebral Infarction, mTICI, score ≥ 2b) and 3-month functional independence (modified Rankin Scale, mRS, ≤ 2).
Results: We included 761 AIS patients with anterior circulation LVO (mean age 73.5 ± 12.8 years; 44.8% males; mean baseline NIHSS 16 ± 5). After propensity score, there were 365 patients ≤ 80 years old (52% bridging therapy) and 187 patients > 80 years old (57% bridging therapy). In both age groups of patients, we found no statistically significant differences in the rates of any ICH, sICH, successful recanalization and 3-month mortality and functional independence between bridging therapy and direct MT groups.
Conclusion: In our population, safety and efficacy outcomes of bridging therapy versus direct MT did not differ in both AIS patients ≤ 80 and > 80 years old.
(© 2024. The Author(s) under exclusive licence to Belgian Neurological Society.)
Databáze: MEDLINE
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