title: The safety and efficacy of bridging full-dose IV-IA thrombolysis in acute ischemic stroke patients with MCA occlusion: a comparison with IV thrombolysis alone.
abstract: OBJECTIVE
  Early recanalization of the occluded cerebral artery is substantial for clinical improvement in acute ischemic stroke (IS) patients. The rate of achieved recanalizations using IVT is low. The aim of this study was to compare the safety and efficacy of bridging full-dose intravenous-intraarterial (IV-IA) thrombolysis to IVT alone in acute IS patients with occluded MCA.
  
  
  METHODS
  Seventy-nine consecutive IS patients with MCA occlusion were treated either with IVT alone (historic controls, Group 1) or with full-dose IV-IA thrombolysis (Group 2). Stroke severity was evaluated using NIHSS, achieved recanalizations using transcranial Doppler (Group 1) or angiography (Group 2). Occurrence of ICH including SICH was evaluated after 24 hours. 90-day clinical outcome was evaluated using modified Rankin Scale (mRS).
  
  
  RESULTS
  Group 1 consisted of 50 patients (24 males, mean age 70.8±10.2 years) and Group 2 of 29 patients (14 males, mean age 67.8±10.0 years). No difference was found in the initial NIHSS (median 16 vs. 17) and other baseline parameters including time from stroke onset to IVT. Patients treated with bridging therapy had a higher number of achieved MCA recanalization (75.9 vs. 32.0%, P=0.0002), similar number of SICH (6.0 vs. 6.9%, P=1.000) and 34.5% of them achieved mRS 0-2 versus 28.0% of patients treated with IVT (P=0.546). Patients with shorter TR had significantly better clinical outcome (P=0.019).
  
  
  CONCLUSIONS
  Bridging IV-IA thrombolysis seems to be safe and more effective than IVT alone in acute stroke patients with MCA occlusion.
authors: Department of Neurology, Comprehensive Stroke Center, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
authors: Daniel
authors: D
authors: Sanak
authors: Martin
authors: M
authors: Kocher
authors: Tomas
authors: T
authors: Veverka
authors: Michal
authors: M
authors: Kral
authors: Marie
authors: M
authors: Cerna
authors: Jana
authors: J
authors: Zapletalova
authors: Stanislav
authors: S
authors: Burval
authors: David
authors: D
authors: Skoloudik
authors: Andrea
authors: A
authors: Bartkova
authors: Eva
authors: E
authors: Cechakova
authors: Tomas
authors: T
authors: Dornak
authors: Roman
authors: R
authors: Herzig
authors: Petr
authors: P
authors: Kanovsky
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D007262:Infusions, Intravenous; D008297:Male; D020768:Middle Cerebral Artery / Q000187:drug effects; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography