Thrombectomy Alone versus Bridging Therapy in Acute Ischemic Stroke: Preliminary Results of an Experimental Trial.

Background: For patients with acute large vessel occlusion (ALVO) in the anterior circulation who are able to undergo mechani-cal thrombectomy (MTB) within 4.5 hours, the need for intravenous thrombolysis prior to the intervention remains unclear.

Methods: Patients who were eligible for intravenous thrombolysis, who presented with ALVO in the anterior circulation, and who started MTB within 4.5 hours were matched at a 1:1 ratio to a thrombectomy alone group or to a bridging therapy group. Patients in the bridging therapy group were administered intravenous alteplase at a standard dose of 0.9 mg/kg. We evaluated the safety and efficacy of the throm-bectomy alone group compared with the bridging therapy group.

Results: From December 2020 to September 2021, 60 patients were recruited in the study and completed the trial. The baseline para-meters of patients were similar between the two groups. At the 90-day follow-up, 18 patients (60%) in the thrombectomy alone group versus 18 patients (60%) in the bridging therapy group achieved functional independence (odds ratio [OR]: 1, 95% confidence interval [CI], 0.36-2.81). The successful recanalization (Thrombolysis in Cerebral Infarction [TICI] grade 2b to 3) rates on final angiography were 90% and 86.7%, respectively (OR, 0.72, 95% CI, 0.15-3.55). No significant differences were found between the two groups in the occurrence of symptomatic intracranial hemorrhage or 90-day mortality.

Conclusion: Our preliminary results did not show the superiority of thrombectomy alone versus standard bridging therapy in patients with ALVO in the anterior circulation who undergo MTB within 4.5 hours. A larger sample size and other randomized controlled trials remain necessary to validate these results.