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Impact of intravenous thrombolysis on recanalization rates in patients with stroke treated with bridging therapy
- Source :
- European Journal of Neurology. 24:1016-1021
- Publication Year :
- 2017
- Publisher :
- Wiley, 2017.
-
Abstract
- BACKGROUND AND PURPOSE Randomized controlled trials have shown that bridging endovascular therapy (EVT) after intravenous thrombolysis (IVT) therapy improves outcome in patients with stroke with large-artery anterior circulation stroke compared with IVT alone. It remains unknown whether IVT adds any benefit to EVT in these patients. The aim of this study was to assess recanalization rates and thrombus dislocation before initiation of EVT in patients receiving bridging therapy. METHODS All patients in the Bernese stroke registry (2008-2015) in whom bridging therapy was considered were included in this analysis. Relevant recanalization before EVT, thrombus dislocation and increase in thrombus load between initial and control imaging were assessed retrospectively. RESULTS A total of 319 patients were included. Relevant recanalization before EVT occurred in 8.8% and thrombus dislocation in 7.2% of patients before EVT. Recanalization rates were significantly higher in distal compared with large and more proximal vessel occlusions of the anterior circulation (occlusion of internal carotid artery, 5.4%; middle cerebral artery segment M1, 8.1%; middle cerebral artery segment M2, 17.6%) and in drip-and-ship patients compared with mother-ship patients. In multivariable regression analysis the occlusion site was the only independent predictor of relevant recanalization before EVT (P = 0.046). CONCLUSIONS Relevant recanalization after IVT and prior to EVT in patients receiving bridging therapy was highly dependent on the occlusion site. These findings suggest that future randomized controlled trials should consider occlusion site and treatment paradigm to specify patients who benefit most from bridging therapy in comparison to EVT or IVT alone.
- Subjects :
- Male
medicine.medical_specialty
Bridging (networking)
medicine.medical_treatment
030204 cardiovascular system & hematology
Brain Ischemia
law.invention
03 medical and health sciences
0302 clinical medicine
Fibrinolytic Agents
Randomized controlled trial
law
medicine.artery
Occlusion
medicine
Humans
Thrombolytic Therapy
In patient
Registries
Thrombus
Aged
Retrospective Studies
Aged, 80 and over
business.industry
Thrombolysis
Middle Aged
medicine.disease
Surgery
Stroke
Treatment Outcome
Neurology
Middle cerebral artery
Administration, Intravenous
Female
Neurology (clinical)
Internal carotid artery
business
030217 neurology & neurosurgery
Subjects
Details
- ISSN :
- 13515101
- Volume :
- 24
- Database :
- OpenAIRE
- Journal :
- European Journal of Neurology
- Accession number :
- edsair.doi.dedup.....e51141ecbb3cd32924ee94f5c8bf1b28