title: Is bridging with intravenous thrombolysis of any benefit in endovascular therapy for acute ischemic stroke?
abstract: OBJECTIVE
  Large vessel occlusions with heavy clot burden are less likely to improve with intravenous (IV) thrombolysis alone. The purpose of this study was to show whether a combination of IV thrombolysis and endovascular therapy was superior to endovascular treatment alone.
  
  
  METHODS
  Data for 104 patients with acute large artery occlusion treated between 2005 and 2010 were reviewed. Forty-two received endovascular therapy in combination with IV thrombolysis (bridging group), and 62 received endovascular therapy only. Clinical outcome, mortality rate, and symptomatic intracranial hemorrhage (sICH) rate were compared between the two groups.
  
  
  RESULTS
  The two groups had similar demographic and vascular risk factor distribution, as well as National Institutes of Health Stroke Scale score on admission (mean±SD: 14.8±4.7 and 16.0±5.3; P=0.23). No difference was found in Thrombolysis in Myocardial Infarction recanalization rates (score of 2 or 3) after combined or endovascular therapy alone (83.33% and 79.03%; P=0.585). Favorable outcome, defined as a modified Rankin Scale score of <2 at 90 days, also did not differ between the bridging group and the endovascular-only group (37.5% and 32.76%; P=0.643). There was no difference in mortality rate (19.04% and 29.03%; P=0.5618) and sICH rate (11.9% and 9.68%; P=0.734). A significant difference was found in mean time from symptom onset to treatment in the bridging group and the endovascular-only group (227±88 min vs. 125±40 min; P<0.0001).
  
  
  CONCLUSIONS
  Combining IV thrombolysis with endovascular therapy resulted in similar outcome, revascularization, sICH, and mortality rates compared with endovascular therapy alone. Prospective clinical studies comparing both treatment strategies in acute ischemic stroke are warranted.
authors: Department of Neurology, University at Buffalo, State University of New York, USA; Department of Neurology, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors: Tareq
authors: T
authors: Kass-Hout
authors: Department of Neurology, University at Buffalo, State University of New York, USA; Department of Neurology, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors: Omar
authors: O
authors: Kass-Hout
authors: Department of Neurosurgery, University at Buffalo, State University of New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors: Maxim
authors: M
authors: Mokin
authors: School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, New York, USA.
authors: Danielle M
authors: DM
authors: Thesier
authors: Department of Neurosurgery, University at Buffalo, State University of New York, USA.
authors: Parham
authors: P
authors: Yashar
authors: Department of Neurosurgery, University at Buffalo, State University of New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors: David
authors: D
authors: Orion
authors: Department of Neurosurgery, University at Buffalo, State University of New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors: Shady
authors: S
authors: Jahshan
authors: Department of Neurosurgery, University at Buffalo, State University of New York, USA; Department of Radiology, University at Buffalo, State University of New York, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
authors: L Nelson
authors: LN
authors: Hopkins
authors: Department of Neurosurgery, University at Buffalo, State University of New York, USA; Department of Radiology, University at Buffalo, State University of New York, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA.
authors: Adnan H
authors: AH
authors: Siddiqui
authors: Department of Neurosurgery, University at Buffalo, State University of New York, USA; Department of Radiology, University at Buffalo, State University of New York, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
authors: Kenneth V
authors: KV
authors: Snyder
authors: Department of Neurosurgery, University at Buffalo, State University of New York, USA; Department of Radiology, University at Buffalo, State University of New York, USA; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, New York, USA; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA. Electronic address: elevy@ubns.com.
authors: Elad I
authors: EI
authors: Levy
mesh_terms: D002545:Brain Ischemia / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D002544:Cerebral Infarction / Q000628:therapy; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D020521:Stroke / Q000401:mortality / Q000601:surgery* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; Bridging; Intra-arterial therapy; Tissue plasminogen activator