Inhouse Bridging Thrombolysis Is Associated With Improved Functional Outcome in Patients With Large Vessel Occlusion Stroke: Findings From the German Stroke Registry
Background: Endovascular treatment (EVT) for large vessel occlusion stroke (LVOS) is highly effective. To date, it remains controversial if intravenous thrombolysis (IVT) prior to EVT is superior compared with EVT alone. The aim of our study was to specifically address the question, whether bridging...
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Frontiers Media S.A.
2021-06-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.649108/full |
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| author | Ilko L. Maier Andreas Leha Mostafa Badr Ibrahim Allam Mathias Bähr Ala Jamous Amelie Hesse Marios-Nikos Psychogios Daniel Behme Jan Liman |
| author_facet | Ilko L. Maier Andreas Leha Mostafa Badr Ibrahim Allam Mathias Bähr Ala Jamous Amelie Hesse Marios-Nikos Psychogios Daniel Behme Jan Liman |
| author_sort | Ilko L. Maier |
| collection | DOAJ |
| description | Background: Endovascular treatment (EVT) for large vessel occlusion stroke (LVOS) is highly effective. To date, it remains controversial if intravenous thrombolysis (IVT) prior to EVT is superior compared with EVT alone. The aim of our study was to specifically address the question, whether bridging IVT directly prior to EVT has additional positive effects on reperfusion times, successful reperfusion, and functional outcomes compared with EVT alone.Methods: Patients with LVOS in the anterior circulation eligible for EVT with and without prior IVT and direct admission to endovascular centers (mothership) were included in this multicentric, retrospective study. Patient data was derived from the German Stroke Registry (an open, multicenter, and prospective observational study). Outcome parameters included groin-to-reperfusion time, successful reperfusion [defined as a Thrombolysis in Cerebral Infarction (TICI) scale 2b-3], change in National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and mortality at 90 days.Results: Of the 881 included mothership patients with anterior circulation LVOS, 486 (55.2%) received bridging therapy with i.v.-rtPA prior to EVT, and 395 (44.8%) received EVT alone. Adjusted, multivariate linear mixed effect models revealed no difference in groin-to-reperfusion time between the groups (48 ± 36 vs. 49 ± 34 min; p = 0.299). Rates of successful reperfusion (TICI ≥ 2b) were higher in patients with bridging IVT (fixed effects estimate 0.410, 95% CI, 0.070; 0.750, p = 0.018). There was a trend toward a higher improvement in the NIHSS during hospitalization [ΔNIHSS: bridging-IVT group 8 (IQR, 9.8) vs. 4 (IQR 11) points in the EVT alone group; fixed effects estimate 1.370, 95% CI, −0.490; 3.240, p = 0.149]. mRS at 90 days follow-up was lower in the bridging IVT group [3 (IQR, 4) vs. 4 (IQR, 4); fixed effects estimate −0.350, 95% CI, −0.680; −0.010, p = 0.041]. There was a non-significantly lower 90 day mortality in the bridging IVT group compared with the EVT alone group (22.4% vs. 33.6%; fixed effects estimate 0.980, 95% CI −0.610; 2.580, p = 0.351). Rates of any intracerebral hemorrhage did not differ between both groups (4.1% vs. 3.8%, p = 0.864).Conclusions: This study provides evidence that bridging IVT might improve rates of successful reperfusion and long-term functional outcome in mothership patients with anterior circulation LVOS eligible for EVT. |
| first_indexed | 2024-12-14T17:56:11Z |
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| language | English |
| last_indexed | 2024-12-14T17:56:11Z |
| publishDate | 2021-06-01 |
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| series | Frontiers in Neurology |
| spelling | doaj.art-82e70d6127e548749985729509fcd2522022-12-21T22:52:33ZengFrontiers Media S.A.Frontiers in Neurology1664-22952021-06-011210.3389/fneur.2021.649108649108Inhouse Bridging Thrombolysis Is Associated With Improved Functional Outcome in Patients With Large Vessel Occlusion Stroke: Findings From the German Stroke RegistryIlko L. Maier0Andreas Leha1Mostafa Badr2Ibrahim Allam3Mathias Bähr4Ala Jamous5Amelie Hesse6Marios-Nikos Psychogios7Daniel Behme8Jan Liman9Department of Neurology, University Medical Center Göttingen, Göttingen, GermanyDepartment of Medical Statistics, University Medical Center Göttingen, Göttingen, GermanyDepartment of Neurology, University Medical Center Göttingen, Göttingen, GermanyDepartment of Neurology, University Medical Center Göttingen, Göttingen, GermanyDepartment of Neurology, University Medical Center Göttingen, Göttingen, GermanyDepartment of Neuroradiology, University Medical Center Göttingen, Göttingen, GermanyDepartment of Neuroradiology, University Medical Center Göttingen, Göttingen, GermanyDepartment of Neuroradiology, Universitätsspital Basel, Basel, SwitzerlandDepartment of Neuroradiology, University Hospital Magdeburg, Magdeburg, GermanyDepartment of Neurology, University Medical Center Göttingen, Göttingen, GermanyBackground: Endovascular treatment (EVT) for large vessel occlusion stroke (LVOS) is highly effective. To date, it remains controversial if intravenous thrombolysis (IVT) prior to EVT is superior compared with EVT alone. The aim of our study was to specifically address the question, whether bridging IVT directly prior to EVT has additional positive effects on reperfusion times, successful reperfusion, and functional outcomes compared with EVT alone.Methods: Patients with LVOS in the anterior circulation eligible for EVT with and without prior IVT and direct admission to endovascular centers (mothership) were included in this multicentric, retrospective study. Patient data was derived from the German Stroke Registry (an open, multicenter, and prospective observational study). Outcome parameters included groin-to-reperfusion time, successful reperfusion [defined as a Thrombolysis in Cerebral Infarction (TICI) scale 2b-3], change in National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and mortality at 90 days.Results: Of the 881 included mothership patients with anterior circulation LVOS, 486 (55.2%) received bridging therapy with i.v.-rtPA prior to EVT, and 395 (44.8%) received EVT alone. Adjusted, multivariate linear mixed effect models revealed no difference in groin-to-reperfusion time between the groups (48 ± 36 vs. 49 ± 34 min; p = 0.299). Rates of successful reperfusion (TICI ≥ 2b) were higher in patients with bridging IVT (fixed effects estimate 0.410, 95% CI, 0.070; 0.750, p = 0.018). There was a trend toward a higher improvement in the NIHSS during hospitalization [ΔNIHSS: bridging-IVT group 8 (IQR, 9.8) vs. 4 (IQR 11) points in the EVT alone group; fixed effects estimate 1.370, 95% CI, −0.490; 3.240, p = 0.149]. mRS at 90 days follow-up was lower in the bridging IVT group [3 (IQR, 4) vs. 4 (IQR, 4); fixed effects estimate −0.350, 95% CI, −0.680; −0.010, p = 0.041]. There was a non-significantly lower 90 day mortality in the bridging IVT group compared with the EVT alone group (22.4% vs. 33.6%; fixed effects estimate 0.980, 95% CI −0.610; 2.580, p = 0.351). Rates of any intracerebral hemorrhage did not differ between both groups (4.1% vs. 3.8%, p = 0.864).Conclusions: This study provides evidence that bridging IVT might improve rates of successful reperfusion and long-term functional outcome in mothership patients with anterior circulation LVOS eligible for EVT.https://www.frontiersin.org/articles/10.3389/fneur.2021.649108/fullischemic strokeLVOSbridgingendovascular treatmentrtPA |
| spellingShingle | Ilko L. Maier Andreas Leha Mostafa Badr Ibrahim Allam Mathias Bähr Ala Jamous Amelie Hesse Marios-Nikos Psychogios Daniel Behme Jan Liman Inhouse Bridging Thrombolysis Is Associated With Improved Functional Outcome in Patients With Large Vessel Occlusion Stroke: Findings From the German Stroke Registry Frontiers in Neurology ischemic stroke LVOS bridging endovascular treatment rtPA |
| title | Inhouse Bridging Thrombolysis Is Associated With Improved Functional Outcome in Patients With Large Vessel Occlusion Stroke: Findings From the German Stroke Registry |
| title_full | Inhouse Bridging Thrombolysis Is Associated With Improved Functional Outcome in Patients With Large Vessel Occlusion Stroke: Findings From the German Stroke Registry |
| title_fullStr | Inhouse Bridging Thrombolysis Is Associated With Improved Functional Outcome in Patients With Large Vessel Occlusion Stroke: Findings From the German Stroke Registry |
| title_full_unstemmed | Inhouse Bridging Thrombolysis Is Associated With Improved Functional Outcome in Patients With Large Vessel Occlusion Stroke: Findings From the German Stroke Registry |
| title_short | Inhouse Bridging Thrombolysis Is Associated With Improved Functional Outcome in Patients With Large Vessel Occlusion Stroke: Findings From the German Stroke Registry |
| title_sort | inhouse bridging thrombolysis is associated with improved functional outcome in patients with large vessel occlusion stroke findings from the german stroke registry |
| topic | ischemic stroke LVOS bridging endovascular treatment rtPA |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.649108/full |
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