Clinical and Neuroimaging Outcomes of Direct Thrombectomy vs Bridging Therapy in Large Vessel Occlusion: Analysis of the SELECT Cohort Study.
Aged
Aged, 80 and over
Arterial Occlusive Diseases
/ drug therapy
Cerebral Arterial Diseases
/ drug therapy
Cohort Studies
Female
Fibrinolytic Agents
/ administration & dosage
Humans
Ischemic Stroke
/ drug therapy
Male
Middle Aged
Outcome Assessment, Health Care
/ statistics & numerical data
Thrombectomy
/ statistics & numerical data
Time-to-Treatment
/ statistics & numerical data
Tissue Plasminogen Activator
/ administration & dosage
Journal
Neurology
ISSN: 1526-632X
Titre abrégé: Neurology
Pays: United States
ID NLM: 0401060
Informations de publication
Date de publication:
08 06 2021
08 06 2021
Historique:
received:
29
05
2020
accepted:
11
03
2021
pubmed:
21
4
2021
medline:
14
7
2021
entrez:
20
4
2021
Statut:
ppublish
Résumé
To evaluate the comparative safety and efficacy of direct endovascular thrombectomy (dEVT) compared to bridging therapy (BT; IV tissue plasminogen activator + EVT) and to assess whether BT potential benefit relates to stroke severity, size, and initial presentation to EVT vs non-EVT center. In a prospective multicenter cohort study of imaging selection for endovascular thrombectomy (Optimizing Patient Selection for Endovascular Treatment in Acute Ischemic Stroke [SELECT]), patients with anterior circulation large vessel occlusion (LVO) presenting to EVT-capable centers within 4.5 hours from last known well were stratified into BT vs dEVT. The primary outcome was 90-day functional independence (modified Rankin Scale [mRS] score 0-2). Secondary outcomes included a shift across 90-day mRS grades, mortality, and symptomatic intracranial hemorrhage. We also performed subgroup analyses according to initial presentation to EVT-capable center (direct vs transfer), stroke severity, and baseline infarct core volume. We identified 226 LVOs (54% men, mean age 65.6 ± 14.6 years, median NIH Stroke Scale [NIHSS] score 17, 28% received dEVT). Median time from arrival to groin puncture did not differ in patients with BT when presenting directly (dEVT 1.43 [interquartile range (IQR) 1.13-1.90] hours vs BT 1.58 [IQR 1.27-2.02] hours, BT appears to be associated with better clinical outcomes, especially with milder NIHSS scores, smaller presentation core volumes, and those who were "dripped and shipped." We did not observe any potential benefit of BT in patients with more severe strokes. ClinicalTrials.gov Identifier: NCT02446587. This study provides Class III evidence that for patients with ischemic stroke from anterior circulation LVO within 4.5 hours from last known well, BT compared to dEVT leads to better 90-day functional outcomes.
Identifiants
pubmed: 33875560
pii: WNL.0000000000012063
doi: 10.1212/WNL.0000000000012063
pmc: PMC8205460
doi:
Substances chimiques
Fibrinolytic Agents
0
Tissue Plasminogen Activator
EC 3.4.21.68
Banques de données
ClinicalTrials.gov
['NCT02446587']
Types de publication
Clinical Study
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e2839-e2853Informations de copyright
© 2021 American Academy of Neurology.
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