Efficacy and Safety of Bridging Lysis Compared to Direct Thrombectomy at Different Occlusion Sites in Acute Ischemic Stroke of the Anterior and Posterior Circulation.

PURPOSE: We investigated whether bridging therapy (BL) was more effective as compared to thrombectomy alone (DT) in the posterior circulation and M2 occlusions as compared to M1 occlusions in patients with acute ischemic stroke.

MATERIAL AND

METHODS

This study is based on data from 4853 patients that were enrolled in the nationwide registry of the German Society for Neuroradiology between 2018 and 2022. Outcome measures included the relative proportion of patients with a National Institutes of Health Stroke Scale score of 0-8 at discharge, successful reperfusion defined as a modified treatment in cerebral infarction score of 2b, 2c, or 3, the occurrence of intracranial hemorrhage, embolism in another vascular territory and mortality.

RESULTS

There were no significant differences (p < 0.05) between the groups with DT and BL in periprocedural complications, mortality and functional outcome for patients with occlusion of the M1 and M2 segment. Significant higher recanalization rates were found for the M1 segment (BL 89.3%, DT 84.9%, p = 0.009) in patients treated with BL; no significant differences were found between the groups for the M2 segment. In patients with basilar occlusion, we found a significantly higher embolization rate in patients with BL (BL 2.7%, DT 1%, p = 0.018) and all other outcome measures did not differ significantly.

CONCLUSION

Our analysis does not show significant differences in mortality, hemorrhage and functional outcome rates between BL and DT for patients with M1, M2 and basilar occlusions. BL was not associated with different recanalization rates in patients with M2 and basilar occlusions.