Background and purpose: The aim was to assess functional and radiological outcomes after bridging therapy (intravenous thrombolysis plus mechanical thrombectomy) versus direct mechanical thrombectomy (MT) in unknown onset stroke patients. Methods: A cohort study was conducted on prospectively collected data from unknown onset stroke patients who received endovascular procedures at ≤6 h from symptom recognition or awakening time. Results: Of the 349 patients with a 10-point Alberta Stroke Program Early Computed Tomography Score (ASPECTS), 248 received bridging and 101 received direct MT. Of the 134 patients with 6–9-point ASPECTS, 123 received bridging and 111 received direct MT. Each patient treated with bridging was propensity score matched with a patient treated with direct MT for age, sex, study period, pre-stroke disability, stroke severity, type of stroke onset, symptom recognition to groin time (or awakening to groin time), ASPECTS and procedure time. In the two matched groups with 10-point ASPECTS (n = 73 vs. n = 73), bridging was associated with higher rates of excellent outcome (46.6% vs. 28.8%; odds ratio 2.302, 95% confidence interval 1.010–5.244) and successful recanalization (83.6% vs. 63%; odds ratio 3.028, 95% confidence interval 1.369–6.693) compared with direct MT; no significant association was found between bridging and direct MT with regard to rate of symptomatic intracerebral hemorrhage (0% vs. 1.4%). In the two matched groups with 6–9-point ASPECTS (n = 45 vs. n = 45), no significant associations were found between bridging and direct MT with regard to rates of excellent functional outcome (44.4% vs. 31.1%), successful recanalization (73.3% vs. 76.5%) and symptomatic intracerebral hemorrhage (0% vs. 0%). Conclusions: Bridging at ≤ 6 h of symptom recognition or awakening time was associated with better functional and radiological outcomes in unknown onset stroke patients with 10-point ASPECTS.

Functional and radiological outcomes after bridging therapy versus direct thrombectomy in stroke patients with unknown onset: Bridging therapy versus direct thrombectomy in unknown onset stroke patients with 10-point ASPECTS / Cappellari, M.; Saia, V.; Pracucci, G.; Sallustio, F.; Gandini, R.; Nappini, S.; Nencini, P.; Vallone, S.; Zini, A.; Bigliardi, G.; Granata, F.; Grillo, F.; Cioni, S.; Tassi, R.; Bergui, M.; Cerrato, P.; Saletti, A.; De Vito, A.; Gasparotti, R.; Magoni, M.; Taglialatela, F.; Ruggiero, M.; Longoni, M.; Castellan, L.; Malfatto, L.; Menozzi, R.; Castellini, P.; Cosottini, M.; Mancuso, M.; Comai, A.; Franchini, E.; Lozupone, E.; Della Marca, G.; Ciceri, E. F. M.; Bonetti, B.; Zampieri, P.; Inzitari, D.; Mangiafico, S.; Toni, D.. - In: EUROPEAN JOURNAL OF NEUROLOGY. - ISSN 1351-5101. - 28:1(2021), pp. 209-219. [10.1111/ene.14529]

Functional and radiological outcomes after bridging therapy versus direct thrombectomy in stroke patients with unknown onset: Bridging therapy versus direct thrombectomy in unknown onset stroke patients with 10-point ASPECTS

Toni D.
2021

Abstract

Background and purpose: The aim was to assess functional and radiological outcomes after bridging therapy (intravenous thrombolysis plus mechanical thrombectomy) versus direct mechanical thrombectomy (MT) in unknown onset stroke patients. Methods: A cohort study was conducted on prospectively collected data from unknown onset stroke patients who received endovascular procedures at ≤6 h from symptom recognition or awakening time. Results: Of the 349 patients with a 10-point Alberta Stroke Program Early Computed Tomography Score (ASPECTS), 248 received bridging and 101 received direct MT. Of the 134 patients with 6–9-point ASPECTS, 123 received bridging and 111 received direct MT. Each patient treated with bridging was propensity score matched with a patient treated with direct MT for age, sex, study period, pre-stroke disability, stroke severity, type of stroke onset, symptom recognition to groin time (or awakening to groin time), ASPECTS and procedure time. In the two matched groups with 10-point ASPECTS (n = 73 vs. n = 73), bridging was associated with higher rates of excellent outcome (46.6% vs. 28.8%; odds ratio 2.302, 95% confidence interval 1.010–5.244) and successful recanalization (83.6% vs. 63%; odds ratio 3.028, 95% confidence interval 1.369–6.693) compared with direct MT; no significant association was found between bridging and direct MT with regard to rate of symptomatic intracerebral hemorrhage (0% vs. 1.4%). In the two matched groups with 6–9-point ASPECTS (n = 45 vs. n = 45), no significant associations were found between bridging and direct MT with regard to rates of excellent functional outcome (44.4% vs. 31.1%), successful recanalization (73.3% vs. 76.5%) and symptomatic intracerebral hemorrhage (0% vs. 0%). Conclusions: Bridging at ≤ 6 h of symptom recognition or awakening time was associated with better functional and radiological outcomes in unknown onset stroke patients with 10-point ASPECTS.
2021
ASPECTS; stroke; thrombectomy; thrombolysis; unknown onset
01 Pubblicazione su rivista::01a Articolo in rivista
Functional and radiological outcomes after bridging therapy versus direct thrombectomy in stroke patients with unknown onset: Bridging therapy versus direct thrombectomy in unknown onset stroke patients with 10-point ASPECTS / Cappellari, M.; Saia, V.; Pracucci, G.; Sallustio, F.; Gandini, R.; Nappini, S.; Nencini, P.; Vallone, S.; Zini, A.; Bigliardi, G.; Granata, F.; Grillo, F.; Cioni, S.; Tassi, R.; Bergui, M.; Cerrato, P.; Saletti, A.; De Vito, A.; Gasparotti, R.; Magoni, M.; Taglialatela, F.; Ruggiero, M.; Longoni, M.; Castellan, L.; Malfatto, L.; Menozzi, R.; Castellini, P.; Cosottini, M.; Mancuso, M.; Comai, A.; Franchini, E.; Lozupone, E.; Della Marca, G.; Ciceri, E. F. M.; Bonetti, B.; Zampieri, P.; Inzitari, D.; Mangiafico, S.; Toni, D.. - In: EUROPEAN JOURNAL OF NEUROLOGY. - ISSN 1351-5101. - 28:1(2021), pp. 209-219. [10.1111/ene.14529]
File allegati a questo prodotto
File Dimensione Formato  
Cappellari_Functional and radiological outcomes_2021.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 696.2 kB
Formato Adobe PDF
696.2 kB Adobe PDF   Contatta l'autore

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1563405
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 7
  • ???jsp.display-item.citation.isi??? 7
social impact