Bridging thrombolysis improves survival rates at 90 days compared with direct mechanical thrombectomy alone in acute ischemic stroke due to basilar artery occlusion: a systematic review and meta-analysis of 1096 patients
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Bridging thrombolysis improves survival rates at 90 days compared with direct mechanical thrombectomy alone in acute ischemic stroke due to basilar artery occlusion: a systematic review and meta-analysis of 1096 patients. / Lee, Keng Siang; Siow, Isabel; Zhang, John Jy; Syn, Nicholas L; Gillespie, Conor S; Yuen, Linus Zh; Anil, Gopinathan; Yang, Cunli; Chan, Bernard Pl; Sharma, Vijay Kumar; Teoh, Hock-Luen; Mingxue, Jing; Teo, Kevin Soon Hwee; Myint, May Zin; Bhogal, Pervinder; Meyer, Lukas; Schob, Stefan; Sia, Ching-Hui; Mpotsaris, Anastasios; Maus, Volker; Andersson, Tommy; Arnberg, Fabian; Gontu, Vamsi Krishna; Lee, Tsong-Hai; Tan, Benjamin Y Q; Yeo, Leonard Ll.
In: J NEUROINTERV SURG, Vol. 15, No. 10, 10.2023, p. 1039-1045.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Bridging thrombolysis improves survival rates at 90 days compared with direct mechanical thrombectomy alone in acute ischemic stroke due to basilar artery occlusion: a systematic review and meta-analysis of 1096 patients
AU - Lee, Keng Siang
AU - Siow, Isabel
AU - Zhang, John Jy
AU - Syn, Nicholas L
AU - Gillespie, Conor S
AU - Yuen, Linus Zh
AU - Anil, Gopinathan
AU - Yang, Cunli
AU - Chan, Bernard Pl
AU - Sharma, Vijay Kumar
AU - Teoh, Hock-Luen
AU - Mingxue, Jing
AU - Teo, Kevin Soon Hwee
AU - Myint, May Zin
AU - Bhogal, Pervinder
AU - Meyer, Lukas
AU - Schob, Stefan
AU - Sia, Ching-Hui
AU - Mpotsaris, Anastasios
AU - Maus, Volker
AU - Andersson, Tommy
AU - Arnberg, Fabian
AU - Gontu, Vamsi Krishna
AU - Lee, Tsong-Hai
AU - Tan, Benjamin Y Q
AU - Yeo, Leonard Ll
N1 - © Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2023/10
Y1 - 2023/10
N2 - BACKGROUND: Mechanical thrombectomy (MT) is an effective treatment for patients with acute ischemic stroke (AIS) from basilar artery occlusion (BAO).OBJECTIVE: To compare the clinical outcomes of MT, with and without bridging intravenous thrombolysis (IVT), in acute BAO through a systematic review and meta-analysis of the current literature.METHODS: Systematic searches of Medline, EMBASE, and Cochrane Central were undertaken on August 1, 2022. Good functional outcome defined as 90-day modified Rankin Scale score 0-2 was the primary outcome measure. Secondary outcome measures were 90-day mortality, successful post-thrombectomy recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracranial hemorrhage (sICH), and subarachnoid hemorrhage (SAH).RESULTS: Three studies reporting 1096 patients with BAO AIS were included in the meta-analysis. No significant differences in good functional outcome were detected between the two groups (RR=1.28 (95% CI 0.86 to 1.92); p=0.117). However, specifically patients with large artery atherosclerosis (LAA) benefited from bridging IVT (OR=2.52 (95% CI 1.51 to 4.22); p<0.001) with better functional outcomes. There was a significantly lower 90-day mortality rate for patients who underwent bridging IVT compared with MT alone (RR=0.70 (95% CI 0.62 to 0.80); p=0.008). No significant differences were detected in rates of post-treatment recanalization (RR=1.01 (95% CI 0.35 to 2.91); p=0.954), sICH (RR=0.96 (95% CI 0.66 to 1.42); p=0.724), and SAH (RR=0.93 (95% CI 0.31 to 2.83); p=0.563).CONCLUSIONS: In patients with AIS due to BAO, bridging IVT was associated with lower mortality rates at 90 days, compared with direct MT. There were no improved functional outcomes or increased sICH or SAH between both arms, However, patients with LAA benefited from bridging IVT, with better functional outcomes.
AB - BACKGROUND: Mechanical thrombectomy (MT) is an effective treatment for patients with acute ischemic stroke (AIS) from basilar artery occlusion (BAO).OBJECTIVE: To compare the clinical outcomes of MT, with and without bridging intravenous thrombolysis (IVT), in acute BAO through a systematic review and meta-analysis of the current literature.METHODS: Systematic searches of Medline, EMBASE, and Cochrane Central were undertaken on August 1, 2022. Good functional outcome defined as 90-day modified Rankin Scale score 0-2 was the primary outcome measure. Secondary outcome measures were 90-day mortality, successful post-thrombectomy recanalization (modified Thrombolysis in Cerebral Infarction score ≥2b), symptomatic intracranial hemorrhage (sICH), and subarachnoid hemorrhage (SAH).RESULTS: Three studies reporting 1096 patients with BAO AIS were included in the meta-analysis. No significant differences in good functional outcome were detected between the two groups (RR=1.28 (95% CI 0.86 to 1.92); p=0.117). However, specifically patients with large artery atherosclerosis (LAA) benefited from bridging IVT (OR=2.52 (95% CI 1.51 to 4.22); p<0.001) with better functional outcomes. There was a significantly lower 90-day mortality rate for patients who underwent bridging IVT compared with MT alone (RR=0.70 (95% CI 0.62 to 0.80); p=0.008). No significant differences were detected in rates of post-treatment recanalization (RR=1.01 (95% CI 0.35 to 2.91); p=0.954), sICH (RR=0.96 (95% CI 0.66 to 1.42); p=0.724), and SAH (RR=0.93 (95% CI 0.31 to 2.83); p=0.563).CONCLUSIONS: In patients with AIS due to BAO, bridging IVT was associated with lower mortality rates at 90 days, compared with direct MT. There were no improved functional outcomes or increased sICH or SAH between both arms, However, patients with LAA benefited from bridging IVT, with better functional outcomes.
U2 - 10.1136/jnis-2022-019510
DO - 10.1136/jnis-2022-019510
M3 - SCORING: Journal article
C2 - 36175014
VL - 15
SP - 1039
EP - 1045
JO - J NEUROINTERV SURG
JF - J NEUROINTERV SURG
SN - 1759-8478
IS - 10
ER -
