title: Bridging-therapy with intravenous recombinant tissue plasminogen activator improves functional outcome in patients with endovascular treatment in acute stroke.
abstract: BACKGROUND
  Although endovascular treatment for proximal cerebral vessel occlusion is very effective, it remains controversial if intravenous thrombolysis (IVT) prior to endovascular treatment is superior compared to endovascular treatment alone. In this study we compared functional outcomes and recanalization rates of endovascularly treated stroke patients with and without bridging IVT.
  
  
  METHODS
  Patients with acute large artery occlusion within the anterior and posterior cerebral circulation eligible for intraarterial revascularization with and without prior IVT were included in this monocentric, prospective observational study. Modified Rankin Scale (mRS) and National Institute of Health Stroke Scale (NIHSS) were determined at baseline, discharge and 90-days follow up after stroke. Successful reperfusion was defined as a Thrombolysis in Cerebral Infarction (TICI) scale 2b-3.
  
  
  RESULTS
  Of the 109 patients included, 81 (74%) received bridging therapy with i.v.-rtPA prior to endovascular treatment, 28 (26%) received endovascular treatment alone. There was no difference in groin-to-reperfusion time between the groups (54 vs 50min; p=0.657), but a trend towards a higher reperfusion rate in patients with bridging therapy (69 vs 15 patients, p=0.099). Mean improvement of the NIHSS during hospitalization was 8 points (SD; ±8) in the bridging-group and 2 points (SD, ±7) in the non-bridging-group (p=0.001). Number of patients with discharge mRS 0-2 (34 vs 5; p=0.024) and 90-days mRS 0-2 (35 vs 6; p=0.061) was higher in the bridging-group compared to the non-bridging-group.
  
  
  CONCLUSIONS
  This study provides evidence that bridging therapy with i.v.-rtPA improves functional outcome in patients eligible for endovascular treatment. Further studies are needed to confirm our findings and to identify patients most likely benefitting from bridging therapy.
authors.affiliation: Department of Neurology, University Medicine Göttingen, Germany. Electronic address: ilko.maier@med.uni-goettingen.de.
authors.forename: Ilko L
authors.initials: IL
authors.lastname: Maier
authors.affiliation: Department of Neuroradiology, University Medicine Göttingen, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Behme
authors.affiliation: Department of Neurology, University Medicine Göttingen, Germany.
authors.forename: Marlena
authors.initials: M
authors.lastname: Schnieder
authors.affiliation: Department of Neuroradiology, University Medicine Göttingen, Germany.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsogkas
authors.affiliation: Department of Neuroradiology, University Medicine Göttingen, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Schregel
authors.affiliation: Department of Neurology, University Medicine Göttingen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kleinknecht
authors.affiliation: Department of Neurology, University Medicine Göttingen, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Wasser
authors.affiliation: Department of Neurology, University Medicine Göttingen, Germany.
authors.forename: Mathias
authors.initials: M
authors.lastname: Bähr
authors.affiliation: Department of Neuroradiology, University Medicine Göttingen, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Knauth
authors.affiliation: Department of Neuroradiology, University Medicine Göttingen, Germany.
authors.forename: Marios
authors.initials: M
authors.lastname: Psychogios
authors.affiliation: Department of Neurology, University Medicine Göttingen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Liman
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D018709:Statistics, Nonparametric; D020521:Stroke / Q000000981:diagnostic imaging / Q000628:therapy*; D017131:Thrombectomy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: Acute stroke outcome; Endovascular treatment; Ischemic stroke; Thrombolysis