Is bridging therapy still required in stroke due to carotid artery terminus occlusions? - Inserm - Institut national de la santé et de la recherche médicale Accéder directement au contenu
Article Dans Une Revue Journal of Neurointerventional Surgery Année : 2018

Is bridging therapy still required in stroke due to carotid artery terminus occlusions?

Benoit Guillon
  • Fonction : Auteur
  • PersonId : 845013
Gaultier Marnat
Hubert Desal

Résumé

Introduction - Studies comparing endovascular stroke treatment using mechanical thrombectomy (MT) with or without prior IV tissue plasminogen activator (tPa) have included only 30% of internal carotid artery terminus occlusions (ICA-O), a known predictor of recanalization failure with IV tPa. Objective - To carry out a retrospective multicenter analysis of prospectively collected data of consecutive patients to investigate the impact of intravenous thrombolysis on ICA-O by comparing patients treated with MT alone or bridging therapy (BT). Material and methods - Patients with ICA-O treated with MT alone or BT were retrospectively examined and compared. Demographic data, vascular risk factors, treatment modalities, complications, technical and clinical outcomes were recorded. A propensity score (PS) analysis was used to compare modified Rankin Scale (mRS) score at 3 months and intracerebral hemorrhage (ICH) between groups. Results - 141 consecutive patients (60% BT/40% MT) were included between January 2014 and June 2016. Baseline characteristics did not differ between the groups. There was no significant difference in the rate of Thrombolysis in Cerebral Infarction 2b/3, distal emboli, and median number of passes between the groups. There was a significant difference between BT and MT groups in the median time between imaging and groin puncture (median 97 min vs 75, p=0.007), the rate of ICH (44% vs 27%, p=0.05), but not for symptomatic ICH (18% vs 13%, p=0.49). With PS, there was a trend towards a higher rate of ICH (OR=2.3, 95% CI 0.9 to 5.9, p=0.09) in the BT group compared with the MT alone group, with no difference in mRS score ≤2 at 3 months (OR=1.6, 95% CI 0.7 to 3.7, p=0.29). Conclusion - There was no significant difference in clinical outcomes between patients receiving bridging therapy versus direct thrombectomy. Bridging therapy delayed time to groin puncture and increased ICH rate.
Fichier non déposé

Dates et versions

inserm-01935345 , version 1 (26-11-2018)

Identifiants

Citer

Romain Bourcier, Pierre-Louis Alexandre, François Eugène, Béatrice Delasalle-Guyomarch, Benoit Guillon, et al.. Is bridging therapy still required in stroke due to carotid artery terminus occlusions?. Journal of Neurointerventional Surgery, 2018, 10 (7), pp.625 - 628. ⟨10.1136/neurintsurg-2017-013398⟩. ⟨inserm-01935345⟩
145 Consultations
0 Téléchargements

Altmetric

Partager

Gmail Facebook X LinkedIn More