Ev-Christin Heide (Göttingen / DE), Sami Al Kasab (Charleston, SC / US), Pascal Jabbour (Philadelphia, PA / US), Joon-Tae Kim (Gwangju / KR), Stacey Quintero Wolfe (Winston-Salem, NC / US), Ansaar Rai (Morgantown, WV / US), Robert Starke (Miami, FL / US), Marios-Nikos Psychogios (Basel / CH), Amir Shaban (Iowa City, IA / US), Adam Arthur (Memphis, TN / US), Shinichi Yoshimura (Hyogo / JP), Hugo Cuellar (Shreveport, LA / US), Brian Howard (Atlanta, GA / US), Ali Alawieh (Atlanta, GA / US), Daniele G. Romano (Salerno / IT), Omar Tanweer (Houston, TX / US), Justin Mascitelli (San Antonio, TX / US), Isabel Fragata (Lissabon / PT), Adam Polifka (Gainesville, FL / US), Joshua Osbun (St. Louis, MO / US), Roberto Crosa (Montevideo / UY), Charles Matouk (New Haven, CT / US), Min S. Park (Charlottesville, VA / US), Michael R. Levitt (Washington, WA / US), Waleed Brinjikji (Rochester, MN / US), Mark Moss (Arlington, TX / US), Travis Dumont (Tucson, AZ / US), Richard Williamson (Sparta, NC / US), Pedro Navia (Madrid / ES), Peter Kan (Galveston, TX / US), Reade De Leacy (New York, NY / US), Shakeel Chowdhry (Glenview, IL / US), Mohamad Ezzeldin (Kingwood, WV / US), Dr. Daniel Behme (Magdeburg / DE), Alejandro M. Spiotta (Charleston, SC / US), PD Dr. med. Ilko Maier (Göttingen / DE)
Abstract-Text (inkl. Referenzen und Bildunterschriften)
Background: Non-inferiority of bridging thrombolysis (BT) in anterior circulation large vessel occlusion strokes (LVOS) has not been demonstrated by multiple randomized trials. To date, the role of bridging thrombolysis in posterior circulation LVOS remains controversial.
Methods: In this multicenter, retrospective study, stroke patients with LVOS in the posterior circulation who received mechanical thrombectomy (MT) alone or with preceding thrombolysis were selected from the stroke thrombectomy and aneurysm registry (STAR) between January 2014 to January 2021. Effect of BT on functional outcome (modified Rankin scale ≤3 (favorable functional outcome) at 90 days and change in NIHSS form baseline to discharge were investigated using multivariable logistic regression models.
Results: Of the 588 included patients, 394 (67%) were treated with MT alone and 29% received BT with additional MT. Controlling for multiple confounding factors, BT was not predictive for a higher likelihood for favorable functional outcome (OR 1.04, IQR 0.52 to 2.09, p=0.900). There was a strong trend towards a higher improvement in NIHSS in the BT group compared to the MT-only group (linear regression coefficient -3.31, 95 %CI -6.7-0.09, p=0.056) with an effect size of 3 points. Thrombectomy alone did not show any safety advantages compared with BT plus thrombectomy.
Conclusions: This analysis of a large, multicenter stroke database showed similar functional outcomes andcomplication rates in patients with- and without BT in posterior circulation LVOS treated with MT. These results do not support omitting thrombolysis before mechanical thrombectomy in eligible patients and require further investigation.