Does bridging therapy in mechanical thrombectomy increase recanalization rates in ischemic stroke patients affected by acute large vessel occlusion?

Abstract

Both intravenous thrombolysis with tissue plasminogen activator (IV-rtPA) and mechanical thrombectomy (MT) increase recanalization rates. We assessed if bridging-therapy (the concomitant use of rtPA and MT) could increase the recanalization rates and reduce the number of procedural passes in patients suffering from acute ischemic stroke (AIS) when compared to MT alone. Analysis of type of device used, stentriever or aspiration catheter, is also reported. 334 mechanically extracted thrombi were collected from two partner hospitals: Beaumont (Dublin) and Sahlgrenska (Gothenburg). 158 patients (47.3%) were treated with bridging-therapy, while 176 (52.7%) underwent MT alone. Recanalization rate was defined by using the modified Thrombolysis In Cerebral Infarction (mTICI) score. Non-parametric Kruskal-Wallis test was used for statistical analysis. Bridging-therapy reduced the total number of passes to remove the clot (mean for MT+rtPA=2.27±2.10, MT alone=2.63±1.88, H1=4.376, p=0.036*). Analysing the device, rtPA lowered the overall number of passes using stentriever devices (mean for MT+rtPA=1.57±1.12, MT alone=2.36±1.48, H1=8.303, p=0.004*), but not for aspiration (mean for MT+rt-PA=1.78±1.22, MT alone=2.03±1.47, for H1=0.795, p=0.372). Also, when using both devices no significant reduction of number of passes was observed (mean for MT+rtPA=3.29±2.90, MT alone=3.83±2.20, H1=3.027, p=0.082). There was no significant effect on final mTICI score using bridging-therapy when compared to MT alone (H1=1.163, p=0.281). This small study suggests that bridging-therapy lowers the number of procedural passes in MT procedures, specifically when using stentriever devices. However, this did not have a significant effect on final mTICI score. Funding: Science Foundation Ireland (Grant Number 13/RC/2073) and Cerenovus.