Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion

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Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion. / Siow, Isabel; Tan, Benjamin Y Q; Lee, Keng Siang; Ong, Natalie; Toh, Emma; Gopinathan, Anil; Yang, Cunli; Bhogal, Pervinder; Lam, Erika; Spooner, Oliver; Meyer, Lukas; Fiehler, Jens; Papanagiotou, Panagiotis; Kastrup, Andreas; Alexandrou, Maria; Zubel, Seraphine; Wu, Qingyu; Mpotsaris, Anastasios; Maus, Volker; Anderson, Tommy; Gontu, Vamsi; Arnberg, Fabian; Lee, Tsong Hai; Chan, Bernard P L; Seet, Raymond C S; Teoh, Hock Luen; Sharma, Vijay K; Yeo, Leonard L L.

In: J STROKE, Vol. 24, No. 1, 01.2022, p. 128-137.

Research output: SCORING: Contribution to journalSCORING: Journal articleResearchpeer-review

Harvard

Siow, I, Tan, BYQ, Lee, KS, Ong, N, Toh, E, Gopinathan, A, Yang, C, Bhogal, P, Lam, E, Spooner, O, Meyer, L, Fiehler, J, Papanagiotou, P, Kastrup, A, Alexandrou, M, Zubel, S, Wu, Q, Mpotsaris, A, Maus, V, Anderson, T, Gontu, V, Arnberg, F, Lee, TH, Chan, BPL, Seet, RCS, Teoh, HL, Sharma, VK & Yeo, LLL 2022, 'Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion', J STROKE, vol. 24, no. 1, pp. 128-137. https://doi.org/10.5853/jos.2021.02082

APA

Siow, I., Tan, B. Y. Q., Lee, K. S., Ong, N., Toh, E., Gopinathan, A., Yang, C., Bhogal, P., Lam, E., Spooner, O., Meyer, L., Fiehler, J., Papanagiotou, P., Kastrup, A., Alexandrou, M., Zubel, S., Wu, Q., Mpotsaris, A., Maus, V., ... Yeo, L. L. L. (2022). Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion. J STROKE, 24(1), 128-137. https://doi.org/10.5853/jos.2021.02082

Vancouver

Bibtex

@article{ef15c1e5a12f4aefba126ddc17ce69b2,
title = "Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion",
abstract = "BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is an effective treatment for patients with basilar artery occlusion (BAO) acute ischemic stroke. It remains unclear whether bridging intravenous thrombolysis (IVT) prior to MT confers any benefit. This study compared the outcomes of acute BAO patients who were treated with direct MT versus combined IVT plus MT.METHODS: This multicenter retrospective cohort study included patients who were treated for acute BAO from eight comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale 0-3 measured at 90 days. Secondary outcome measures included mortality and symptomatic intracranial hemorrhage (sICH).RESULTS: Among 322 patients, 127 (39.4%) patients underwent bridging IVT followed by MT and 195 (60.6%) underwent direct MT. The mean±standard deviation age was 67.5±14.1 years, 64.0% were male and median National Institutes of Health Stroke Scale was 16 (interquartile range, 8 to 25). At 90-day, the rate of favorable functional outcome was similar between the bridging IVT and direct MT groups (39.4% vs. 34.4%, P=0.361). On multivariable analyses, bridging IVT was not as Comorbidisociated with favorable functional outcome, mortality or sICH. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (37.2% vs. 15.5%, P=0.013).CONCLUSIONS: Functional outcomes were similar in BAO patients treated with bridging IVT versus direct MT. In the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT may potentially confer benefit and this warrants further investigation.",
author = "Isabel Siow and Tan, {Benjamin Y Q} and Lee, {Keng Siang} and Natalie Ong and Emma Toh and Anil Gopinathan and Cunli Yang and Pervinder Bhogal and Erika Lam and Oliver Spooner and Lukas Meyer and Jens Fiehler and Panagiotis Papanagiotou and Andreas Kastrup and Maria Alexandrou and Seraphine Zubel and Qingyu Wu and Anastasios Mpotsaris and Volker Maus and Tommy Anderson and Vamsi Gontu and Fabian Arnberg and Lee, {Tsong Hai} and Chan, {Bernard P L} and Seet, {Raymond C S} and Teoh, {Hock Luen} and Sharma, {Vijay K} and Yeo, {Leonard L L}",
year = "2022",
month = jan,
doi = "10.5853/jos.2021.02082",
language = "English",
volume = "24",
pages = "128--137",
journal = "J STROKE",
issn = "2287-6391",
publisher = "Korean Stroke Society",
number = "1",

}

RIS

TY - JOUR

T1 - Bridging Thrombolysis versus Direct Mechanical Thrombectomy in Stroke Due to Basilar Artery Occlusion

AU - Siow, Isabel

AU - Tan, Benjamin Y Q

AU - Lee, Keng Siang

AU - Ong, Natalie

AU - Toh, Emma

AU - Gopinathan, Anil

AU - Yang, Cunli

AU - Bhogal, Pervinder

AU - Lam, Erika

AU - Spooner, Oliver

AU - Meyer, Lukas

AU - Fiehler, Jens

AU - Papanagiotou, Panagiotis

AU - Kastrup, Andreas

AU - Alexandrou, Maria

AU - Zubel, Seraphine

AU - Wu, Qingyu

AU - Mpotsaris, Anastasios

AU - Maus, Volker

AU - Anderson, Tommy

AU - Gontu, Vamsi

AU - Arnberg, Fabian

AU - Lee, Tsong Hai

AU - Chan, Bernard P L

AU - Seet, Raymond C S

AU - Teoh, Hock Luen

AU - Sharma, Vijay K

AU - Yeo, Leonard L L

PY - 2022/1

Y1 - 2022/1

N2 - BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is an effective treatment for patients with basilar artery occlusion (BAO) acute ischemic stroke. It remains unclear whether bridging intravenous thrombolysis (IVT) prior to MT confers any benefit. This study compared the outcomes of acute BAO patients who were treated with direct MT versus combined IVT plus MT.METHODS: This multicenter retrospective cohort study included patients who were treated for acute BAO from eight comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale 0-3 measured at 90 days. Secondary outcome measures included mortality and symptomatic intracranial hemorrhage (sICH).RESULTS: Among 322 patients, 127 (39.4%) patients underwent bridging IVT followed by MT and 195 (60.6%) underwent direct MT. The mean±standard deviation age was 67.5±14.1 years, 64.0% were male and median National Institutes of Health Stroke Scale was 16 (interquartile range, 8 to 25). At 90-day, the rate of favorable functional outcome was similar between the bridging IVT and direct MT groups (39.4% vs. 34.4%, P=0.361). On multivariable analyses, bridging IVT was not as Comorbidisociated with favorable functional outcome, mortality or sICH. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (37.2% vs. 15.5%, P=0.013).CONCLUSIONS: Functional outcomes were similar in BAO patients treated with bridging IVT versus direct MT. In the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT may potentially confer benefit and this warrants further investigation.

AB - BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is an effective treatment for patients with basilar artery occlusion (BAO) acute ischemic stroke. It remains unclear whether bridging intravenous thrombolysis (IVT) prior to MT confers any benefit. This study compared the outcomes of acute BAO patients who were treated with direct MT versus combined IVT plus MT.METHODS: This multicenter retrospective cohort study included patients who were treated for acute BAO from eight comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale 0-3 measured at 90 days. Secondary outcome measures included mortality and symptomatic intracranial hemorrhage (sICH).RESULTS: Among 322 patients, 127 (39.4%) patients underwent bridging IVT followed by MT and 195 (60.6%) underwent direct MT. The mean±standard deviation age was 67.5±14.1 years, 64.0% were male and median National Institutes of Health Stroke Scale was 16 (interquartile range, 8 to 25). At 90-day, the rate of favorable functional outcome was similar between the bridging IVT and direct MT groups (39.4% vs. 34.4%, P=0.361). On multivariable analyses, bridging IVT was not as Comorbidisociated with favorable functional outcome, mortality or sICH. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (37.2% vs. 15.5%, P=0.013).CONCLUSIONS: Functional outcomes were similar in BAO patients treated with bridging IVT versus direct MT. In the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT may potentially confer benefit and this warrants further investigation.

U2 - 10.5853/jos.2021.02082

DO - 10.5853/jos.2021.02082

M3 - SCORING: Journal article

C2 - 35135066

VL - 24

SP - 128

EP - 137

JO - J STROKE

JF - J STROKE

SN - 2287-6391

IS - 1

ER -