Bridging versus direct endovascular therapy in basilar artery occlusion

SO NO MEASUREMENT OF 100% RECOVERY?  What the fuck do you think stroke research is for?  It is not to get 'better', it is to completely recover. Talk to survivors sometime without using your tyranny of low expectations to justify failure.

 Bridging versus direct endovascular therapy in basilar artery occlusion

1. http://orcid.org/0000-0002-2607-5815Sergio Nappini1,
2. http://orcid.org/0000-0003-3941-7383Francesco Arba2,
3. Giovanni Pracucci3,
4. Valentina Saia4,
5. Danilo Caimano3,
6. Nicola Limbucci1,
7. Leonardo Renieri1,
8. Andrea Zini5,
9. Domenico Inzitari3,
10. Danilo Toni6,
11. Salvatore Mangiafico1
12. On behalf of the Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS) Study Group

1. Correspondence to Dr Sergio Nappini, Neurovascular Interventional Unit, University Hospital Careggi, Firenze, Italy; nappini@gmail.com

Abstract

Background We evaluated safety and efficacy of intravenous recombinant tissue Plasminogen Activator plus endovascular (bridging) therapy compared with direct endovascular therapy in patients with ischaemic stroke due to basilar artery occlusion (BAO).

Methods From a national prospective registry of endovascular therapy in acute ischaemic stroke, we selected patients with BAO. We compared bridging and direct endovascular therapy evaluating vessel recanalisation, haemorrhagic transformation at 24–36 hours; procedural complications; and functional outcome at 3 months according to the modified Rankin Scale. We ran logistic and ordinal regression models adjusting for age, sex, National Institutes of Health Stroke Scale (NIHSS), onset-to-groin-puncture time.

Results We included 464 patients, mean(±SD) age 67.7 (±13.3) years, 279 (63%) males, median (IQR) NIHSS=18 (10–30); 166 (35%) received bridging and 298 (65%) direct endovascular therapy. Recanalisation rates and symptomatic intracerebral haemorrhage were similar in both groups (83% and 3%, respectively), whereas distal embolisation was more frequent in patients treated with direct endovascular therapy (9% vs 3%; p=0.009). In the whole population, there was no difference between bridging and direct endovascular therapy regarding functional outcome at 3 months (OR=0.79; 95% CI=0.55 to 1.13). However, in patients with onset-to-groin-puncture time ≤6 hours, bridging therapy was associated with lower mortality (OR=0.53; 95% CI=0.30 to 0.97) and a shift towards better functional outcome in ordinal analysis (OR=0.65; 95% CI=0.42 to 0.98).

Conclusions In ischaemic stroke due to BAO, when endovascular therapy is initiated within 6 hours from symptoms onset, bridging therapy resulted in lower mortality and better functional outcome compared with direct endovascular therapy.

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All free text entered below will be published.

http://dx.doi.org/10.1136/jnnp-2020-325328