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Bridge mechanical thrombectomy may be a better choice for acute large vessel occlusions

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Abstract

Direct mechanical thrombectomy (DMT) was confirmed non-inferior to bridge mechanical thrombectomy (BMT, MT preceded by intravenous alteplase within 4.5 h after symptom onset) for acute ischemic stroke with large vessel occlusions (AIS-LVO) in mothership patients. However, the noninferiority of DMT in the general population (including drip and ship mode) is controversial, and the impact of thrombolysis on retrieval attempts remains uncertain. This was a post-hoc analysis of a multi-center, prospective enrolled study. Patients were divided into the BMT group and the DMT group. Baseline characteristics and clinical outcomes were compared by using univariate analysis, multivariable analysis, and propensity score matching analysis, respectively. Of all 245 patients enrolled in this study, 79 (32.2%) patients underwent BMT. In the multivariable analysis, the ratio of excellent prognosis (defined as modified Rankin Scale [mRS] score 0–1 at 90 days) was significantly higher in the BMT group compared with the DMT group (odds ratio, 2.731; 95% confidence interval, 1.238–6.023; P = 0.013). The ratio of good prognosis (mRS score 0–2 at 90 days), successful recanalization rate [modified Thrombolysis In Cerebral Ischemia (mTICI) score 2b-3] and mortality rate were similar between the two groups. The excellent prognosis rate was significantly higher in the BMT group after propensity score matching (P = 0.023). BMT was associated with a higher ratio of excellent prognosis (mRS 0–1) and a similar successful recanalization rate without increasing peri-operation complications compared with DMT in AIS-LVO patients. It is prudent to continue BMT until further data is available.

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Acknowledgments

We sincerely appreciated all contributions from researchers in Captor stent retriever workgroup.

Funding

The original study (identifying the non-inferiority of multi-stent Captor™ stent to Solitaire™ FR retriever, https://www.chictr.org.cn/, register code: ChiCTR1900025256) was funded by Strokecare medical Co.,LTD, Shanghai, China.

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  1. Mingming Zha and Kangmo Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, Jiangsu, China

    Mingming Zha, Haodi Cai, Qingwen Yang & Xinfeng Liu

  2. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Xuanwu District, No. 305 Zhongshan East Road, Nanjing, 210002, Jiangsu, China

    Kangmo Huang, Dong Yang, Lulu Xiao, Rui Liu & Xinfeng Liu

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  1. Mingming Zha
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Contributions

MMZ: drafting/revising the manuscript, analysis or interpretation of data, statistical analysis. KMH: drafting/revising the manuscript, analysis or interpretation of data, statistical analysis. DY, LLX, HDC, QWY: revising the manuscript, analysis, or interpretation of data. XFL, RL: acquisition of data, revising the manuscript, study concept or design, study supervision, obtaining funding.

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Correspondence to Rui Liu or Xinfeng Liu.

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Conflicts of interest

The original study (identifying the non-inferiority of multi-stent Captor™ stent to Solitaire™ FR retriever, register code: ChiCTR1900025256) was funded by Strokecare medical Co.,LTD, Shanghai, China. Prof. Xinfeng Liu served as the principal investigator for the Captor Clinical Trial sponsored by Shanghai Strokecare Medical Co.LTD. He also reported personal fees from Medtronic and speaker fees from Medtronic, Abbott, and Johnson & Johnson, outside the submitted work. Dr. Rui Liu served as a researcher for the Captor Clinical Trial and provided consultation to Shanghai Strokecare Medical Co.LTD.

Ethics approval

The original study was proved by the ethnic committee of Jinling Hospital and participating centers (2017NZQX-002–01). This study was approved by the institutional ethics committee, which also waived informed consent due to the retrospective nature of this study.

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Zha, M., Huang, K., Yang, D. et al. Bridge mechanical thrombectomy may be a better choice for acute large vessel occlusions. J Thromb Thrombolysis 52, 291–300 (2021). https://doi.org/10.1007/s11239-020-02307-0

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