Direct endovascular treatment: an alternative for bridging therapy in anterior circulation large-vessel occlusion stroke.

Background And Purpose: Whether intravenous thrombolysis prior to endovascular treatment in patients with anterior circulation large-vessel occlusion (LVO) is indispensable remains unclear. The aim was to retrospectively compare, in a Chinese population, the effectiveness and safety of direct endovascular treatment (DEVT) initiated within 4.5 h after onset with bridging therapy in acute anterior circulation LVO stroke patients.

Methods: A total of 363 patients, 160 in the bridging therapy group and 203 in the DEVT group, were enrolled between 2014 and 2016. Using propensity score matching analysis, 276 patients were matched. A modified Rankin Scale score of 0-2 was considered as good functional outcome.

Results: Good functional outcome at 90 days in the DEVT group [40.6% (56/138)] did not significantly differ from that in the bridging group [44.9% (62/138)] (P = 0.53). Rates of symptomatic intracranial hemorrhage [13.8% (19/138) vs. 13.0% (18/138), P = 1.00] and mortality [25.4% (35/138) vs. 23.9% (33/138), P = 0.88] within 90 days were also not significantly different. Patients in the DEVT group had a lower rate of asymptomatic intracranial hemorrhage [28.3% (39/138) vs. 44.9% (62/138), P = 0.01] and a higher rate of successful reperfusion [92.0% (127/138) vs. 81.9% (113/138), P = 0.02].

Conclusions: Our results suggest that, in Chinese patients with anterior circulation LVO stroke, direct endovascular mechanical thrombectomy initiated within an intravenous thrombolysis time window carries similar effectiveness to that of bridging therapy and a decreased asymptomatic intracranial hemorrhage risk. DEVT may be an alternative for bridging therapy. Future randomized controlled trials are warranted.