The following is a summary of “Bridging Thrombolysis Before Endovascular Therapy in Stroke Patients With Faster Core Growth,” published in the May 2023 issue of Neurology by Lin, et al.

The efficacy of endovascular thrombectomy (EVT) compared to bridging intravenous thrombolysis (IVT) in acute ischemic stroke patients is still uncertain. Therefore, for a study, researchers sought to assess whether the rate of ischemic core growth influenced patient outcomes after receiving either bridging IVT or direct EVT.

A retrospective cohort study used data from the International Stroke Perfusion Imaging Registry (INSPIRE). The study included acute ischemic stroke patients who underwent perfusion CT within 4.5 hours of stroke onset. Patients were categorized into two groups: those who underwent direct EVT and those who received bridging IVT, followed by EVT. The rate of ischemic core growth was determined by calculating the acute ischemic core volume on perfusion CT divided by the time from stroke onset to perfusion CT. The core growth rate was further classified as fast (>15 mL/h) or slow (≤15 mL/h). The primary outcome assessed was the proportion of patients with a modified Rankin scale score of 0-2 at 3 months. Secondary outcomes included successful thrombectomy reperfusion (defined by modified Thrombolysis in Cerebral Infarction score of 2b-3) and the time from groin puncture to reperfusion.

Among the 1,221 EVT patients in the INSPIRE database, 323 met the inclusion criteria. Of these, 82 patients underwent direct EVT, while 241 received bridging IVT. Bridging IVT was associated with a higher rate of good clinical outcomes in patients with fast core growth compared to direct EVT (39% vs. 7%; odds ratio [OR] 8.75 [1.96-39.1]; p = 0.005). However, no significant difference was observed between the two groups in patients with slowcore growth (55% vs. 55% for direct EVT; OR 1.00 [0.53-1.87]; p = 0.989). Among patients with fast core growth, the reperfusion rate was comparable between the bridging IVT and direct EVT groups (80% vs. 76%; p = 0.616). However, patients who received bridging IVT achieved reperfusion earlier, with a median groin-to-reperfusion time of 63.0 minutes compared to 94.0 minutes for direct EVT (p = 0.005).

Bridging IVT was found to be more beneficial for patients with fast core growth, likely due to its ability to facilitate clot removal and reduce time to reperfusion. These findings have implications for selecting the appropriate treatment approach, particularly in high-risk individuals requiring long-term EVT therapy.

Source: n.neurology.org/content/100/20/e2083