MECHANICAL THROMBECTOMY WITH PRIOR BRIDGING

INTRAVENOUS THROMBOLYSIS THERAPY COMPARED TO DIRECT

MECHANICAL THROMBECTOMY AT A REFERENCE CENTRE.
Laura Fernández Pérez1; Jenifer del Pino Castellano Santana1, Laura María Pérez Navarro1, Rayco Jiménez Bolaños1,
Irene Sánchez-Miranda Román1, Carmen Nieves Hernández Flores2, Guiomar Pinar Sedeño1, Shahin Mirdavood1,
Naira García García1, Victoria Carlota Mota Balibrea1
1 Complejo Hospitalario Universitario Insular Materno Infantil, Neurology, Las Palmas, Spain.
2 University of Las Palmas de Gran Canaria, Mathematics, Las Palmas, Spain.

BACKGROUND AND AIMS METHODS

Practice guidelines recommend intravenous thrombolysis (IVT)
and mechanical thrombectomy (MT) as standard therapy in
candidate patients with large vessel occlusion (LVO). IVT is in
question, as it could imply less safety, therapeutic delay and
added cost. The aim of the study was to compare standard
treatment vs. direct TM in our population.
Retrospective observational analysis of patients with acute
ischemic stroke due to LVO with =<4.5 hours onset treated with
MT from May 2016 to June 2022. In the absence of
contraindications, r-TPA was administered. Demographic,
clinical, radiological and prognostic data were collected.

Overall, n MT MT + IVT
RESULTS TREATMENT, n (%)
252 113 139 IVT P-
Overall
NO YES value
DEMOGRAPHIC CHARACTERISTICS
Recanalization 237 (95.6) 108 (96.4) 129 (94.9) 0.7585
IVT
Overall P-value Direct aspiration 11 (7.9) 2 (3.2) 9 (11.5)
NO YES
MT Stent Retriever 21 (15) 11 (17.7) 10 (12.8) 0.1788
Age, mean 69 71 68 0.1244
Dual 108 (77.1) 49 (79) 59 (75.6)
Sex, n F 105 (41.7) 42 (37.2) 63 (45.3)
0,1915 Distal embolization 19 (11.9) 11 (15.7) 8 (9) 0.1943
(%) M 147 (58.3) 71 (62.8) 76 (54.7)
COMPLICATIONS, n (%)
PERSONAL HISTORY n, (%)
IVT
IVT Overall P-value
Overall P-value NO YES
NO YES
SAH 14 (23.3) 9 (36) 5 (14.3)
HBP 171 (67.9) 77 (68.1) 94 (67.6) 0.9305
IH-2 5 (8.3) 1 (4) 4 (11.4)
Dyslipidemia 119 (47.2) 53 (46.9) 66 (47.5) 0.9270
PH-1 11 (18.3) 5 (20) 6 (17.1)
Diabetes Mellitus 71 (28.2) 43 (38.1) 28 (20.1) 0.0017* Haemorrhagic
0.0122*
transformation PH-1 + SAH 3 (5) 3 (12) 0 (0)
Atrial fibrillation 67 (26.6) 43 (38.1) 24 (17.3) 0.0002*
Ischemic PH-2 15 (25) 3 (12) 12 (34.3)
41 (16.3) 19 (17) 22 (15.8) 0.8086
cardiomyopathy PH-2 + SAH 4 (6.7) 3 (12) 1 (2.9)
Previous stroke 31 (12.3) 18 (15.9) 13 (9.4) 0.1139
New stroke during
Smoker or ex-smoker 100 (67.2) 41 (38) 59 (43.7) 0.1369 11 (4.4) 8 (7.1) 3 (2.2) 0.0693
admission
0 188 (77) 76 (68.5) 112 (84.2) Malignant stroke 24 (3.9) 13 (11.5) 11 (8) 0.3436
Previous 1 38 (15.6) 24 (21.6) 14 (10.5) Pneumonia 51 (20.4) 29 (25.7) 22 (16.1) 0.0607
0.0142*
mRS 2 16 (6.6) 9 (8.1) 7 (5.3)
EVOLUTION AND PROGNOSIS
3 2 (0.8) 2 (1.8) 0 (0)
IVT
RADIOLOGIC CHARACTERISTICS Overall P-value
NO YES
IVT Initial NIHSS, mean 16 16 16 0.7292
Overall P-value
NO YES NIHSS 24 hours after
8 11 7 0.0158*
ASPECTS, mean 10 9 0.0719 treatment, mean
Extracranial 16 (6.3) 9 (8) 7 (5) In-hospital death, n (%) 45 (17.9) 27 (23.9) 18 (12.9) 0.0241*
Occlusion, n 0-2 103 (49) 33 (34.4) 70 (61.4)
Intracranial 200 (79.4) 89 (78.8) 111 (79.9) 0.6071
(%) mRS at 90
Tandem 36 (14.3) 15 (13.3) 21 (15.1) 3-5 57 (27.1) 32 (33.3) 25 (21.9) 0.0004*
days, n (%)
Anterior 240 (95.2) 107 (94.7) 133 (95.7) 6 50 (23.8) 21 (32.3) 19 (16.7)
Circulation, n
0.9250
(%) Posterior 12 (4.8) 6 (5.3) 6 (4.3) * Statistically significant

CONCLUSIONS
Despite a similar proportion of successful recanalization and major complications in both groups, patients treated with direct MT had
higher in-hospital mortality and worse quality of life prognosis. These results should be interpreted with caution, given the difference in
baseline characteristics and comorbidities between groups. Further studies would be necessary to corroborate these results by
homogenizing populations.
References:
1. Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J.
2021;6(1):I-LXII.
2. Turc G, Tsivgoulis G, Audebert HJ, et al. European Stroke Organisation - European Society for Minimally Invasive Neurological Therapy expedited recommendation on
indication for intravenous thrombolysis before mechanical thrombectomy in patients with acute ischaemic stroke and anterior circulation large vessel occlusion [published
correction appears in Eur Stroke J. 2023 Mar;8(1):403]. Eur Stroke J. 2022;7(1):I-XXVI.
3. Suzuki K, Matsumaru Y, Takeuchi M, et al. Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With
Acute Ischemic Stroke: The SKIP Randomized Clinical Trial [published correction appears in JAMA. 2021 May 4;325(17):1795]. JAMA. 2021;325(3):244-253.
4. Trifan G, Biller J, Testai FD. Mechanical Thrombectomy vs Bridging Therapy for Anterior Circulation Large Vessel Occlusion Stroke: Systematic Review and Meta- Copyright © 2023
analysis. Neurology. 2022;98(13):e1361-e1373. Author: Laura Fernández Pérez
5. Matsumoto S, Mikami T, Iwagami M, et al. Mechanical Thrombectomy and Intravenous Thrombolysis in Patients with Acute Stroke: A Systematic Review and Network E-mail: dralfernandez18@hotmail.com
Meta-Analysis. J Stroke Cerebrovasc Dis. 2022;31(7):106491.