Université de Lorraine, CHRU-Nancy, Stroke Unit, CIC-P 1433, INSERM U1116, France (M.D., G.M., S.R.).
Department of Neuroradiology, Université de Lorraine, CHRU-Nancy, INSERM U1254, France (B.G.).
Stroke. 2022 Jan;53(1):e1-e4. doi: 10.1161/STROKEAHA.121.034422. Epub 2021 Nov 3.
Approximately half of the patients with acute ischemic stroke due to anterior circulation large vessel occlusion do not achieve functional independence despite successful reperfusion. We aimed to determine influence of reperfusion strategy (bridging therapy, intravenous thrombolysis alone, or mechanical thrombectomy alone) on clinical outcomes in this population.
From ongoing, prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke registry in France, all patients with anterior circulation large vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3) following reperfusion therapy were included. Primary end point was favorable outcome, defined as 90-day modified Rankin Scale score ≤2. Patient groups were compared using those treated with bridging therapy as reference. Differences in baseline characteristics were reduced after propensity score-matching, with a maximum absolute standardized difference of 14% for occlusion site.
Among 1872 patients included, 970 (51.8%) received bridging therapy, 128 (6.8%) received intravenous thrombolysis alone, and the remaining 774 (41.4%) received MT alone. The rate of favorable outcome was comparable between groups. Excellent outcome (90-day modified Rankin Scale score 0-1) was achieved more frequently in the bridging therapy group compared with the MT alone (odds ratio after propensity score-matching, 0.70 [95% CI, 0.50-0.96]). Regarding safety outcomes, hemorrhagic complications were similar between the groups, but 90-day mortality was significantly higher in the MT alone group compared with the bridging therapy group (odds ratio, 1.60 [95% CI, 1.09-2.37]).
This real-world observational study of patients with anterior circulation large vessel occlusion demonstrated a similar rate of favorable outcome following successful reperfusion with different therapeutic strategies. However, our results suggest that bridging therapy compared with MT alone is significantly associated with excellent clinical outcome and lower mortality.
URL: https://www.clinicaltrials.gov; Unique identifier: NCT03776877.
大约一半由于前循环大血管闭塞导致的急性缺血性脑卒中患者，尽管实现了再灌注，但仍未达到功能独立性。我们旨在确定再灌注策略（桥接治疗、单独静脉溶栓或单独机械取栓）对该人群临床结局的影响。
来自法国正在进行的、前瞻性的、多中心的、观察性的血管内治疗缺血性卒中介入治疗登记研究，所有在前循环大血管闭塞患者中，接受再灌注治疗后成功实现再灌注（改良脑梗死溶栓 2b-3）的患者均被纳入研究。主要终点是良好的结局，定义为 90 天改良 Rankin 量表评分≤2 分。采用以桥接治疗为参考的患者组进行比较。在进行倾向评分匹配后，基线特征的差异得到了缩小，闭塞部位的最大绝对标准化差异为 14%。
在纳入的 1872 例患者中，970 例（51.8%）接受了桥接治疗，128 例（6.8%）接受了单独静脉溶栓治疗，其余 774 例（41.4%）接受了单独机械取栓治疗。各组之间的良好结局率相似。与单独机械取栓治疗相比，桥接治疗组获得更优的结局（90 天改良 Rankin 量表评分 0-1）的比例更高（倾向评分匹配后的比值比，0.70 [95%CI，0.50-0.96]）。在安全性结局方面，各组之间的出血性并发症相似，但单独机械取栓治疗组的 90 天死亡率明显高于桥接治疗组（比值比，1.60 [95%CI，1.09-2.37]）。
本项真实世界观察性研究中，对于前循环大血管闭塞的患者，不同治疗策略成功再灌注后，其良好结局的发生率相似。然而，我们的结果表明，与单独机械取栓治疗相比，桥接治疗与更优的临床结局和更低的死亡率显著相关。
