The Study Of Bridging Therapy And Mechanical Thrombectomy Alone In Acute Anterior Circulation Large Artery Occlusion

objectiveTo investigate the clinical efficacy,safety,advantages and disadvantages of bridging therapy(combined intravenous thrombolysis and thrombectomy,BT)or mechanical thrombectomy alone(MT)in acute anterior circulation stroke due to large-vessel occlusion(LVO).MethodsRetrospective analysis was performed on 55 patients with acute anterior circulation large-vessel occlusive who admitted to the Department of Neurology of Jiangxi People’s Hospital from August 2016 to October 2019.Of the 55 patients,25 were treated with BT,30 were treated with MT.Baseline characteristics,median number of thrombectomy,successful reperfusion,treatment effective rate(divided into basic effective and markedly effective,respectively defined as NIHSS score after treatment descent ≥4 points and ≥8 points),complications(such as symptomatic intracranial hemorrhage,cerebral hernia,respiratory failure,etc),the disease burden(average length of stay,cost of hospitalization),good functional outcomes(contain good prognosis and functional independence,respectively defined as mRS score 0~1 and mRS score 0~2),in-hospital mortality and all-cause death within 90 days of onset were compared between the BT and MT groups,in order to evaluate the clinical efficacy,safety,advantages and disadvantages of the two treatment regimens.ResultsBaseline characteristics: The MT group have higher proportion of hypertension compared with BT group(70%VS36%)(p=0.012),and the median intervals from onset to admission of MT group was significantly higher than that of BT group(5.0hVS2.5h)(p<0.001).There was no significant difference in the rest baseline data between the three groups.Clinical efficacy: The median number of thrombectomy was 2 times and the successful reperfusion rate was around 84% in both MT and BT groups.There was no significant difference between the MT and BT groups in basic effective after treatment at the point of 24h(20%vs32%)and discharge(46.7%vs44%),no significant difference in markedly effective after treatment at the point of 24h(16.7%vs16%)and discharge(33.3%vs24%),no significant difference in functional independence rate after treatment at the point of discharge(26.7%vs36%)and 90 day after onset(43.3%vs36%),no significant difference in good prognosis rate after treatment at the point of discharge(16.7%vs28%)and 90 day after onset(26.7%vs28%)(P>0.05).Safety: No matter in the primary safety endpoint events,such as symptomatic intracranial hemorrhage(26.7%vs24%),cerebral hernia(30%vs24%),hospitalization mortality(10%vs8%)and all-cause mortality(46.7%vs52%)at 90 days after onset,or in the secondary safety endpoint events,such as pulmonary infection(63.3% vs48%),gastrointestinal bleeding(3.3%vs4%),liver dysfunction(20%vs8%),renal dysfunction(13.3%vs8%),electrolyte disturbance(13.3%vs8%),respiratory failure(13.3%vs4%)and heart failure(6.7%vs4%),there was no significant difference between the the MT and BT groups(p>0.05).Burden of disease: The median total hospitalization expenses(98000 yuanVS107000 yuan)and median length of stay(11daysVS13days)were no significant difference between the MT and BT groups(p>0.05).ConclusionsMechanical thrombectomy alone and bridging therapy are both effective therapies for acute anterior circulation large artery occlusion cerebral infarction,and patients can benefit from it.For those who unable to receive intravenous thrombolytic therapy due to miss time window or contraindications,mechanical thrombectomy alone may have the same clinical efficacy and safety as bridging therapy.