Minor stroke: bridging therapy benefits vary with occlusion site


By Mardi Chapman

27 May 2020

Bridging therapy – IV thrombolysis and additional mechanical thrombectomy – is not beneficial for all patients with minor strokes and large vessel occlusion compared to thrombolysis alone, according to a retrospective French study.

The study, presented online at the EAN 2020 Virtual Congress, comprised 500 patients in the MINOR-STROKE cohort who presented to one of 45 French stroke centres between 2015 and 2018.

About 350 patients with NIHSS <6 were intended for IV-tPA treatment alone and the other patients intended for IV-tPA plus thrombectomy.

Neurologist Dr Pierre Seners, from the Ste-Anne Hospital in Paris, told the meeting 8% of the tPA only group eventually required rescue thrombectomy while 31% of the tPA plus thrombectomy group did not require the procedure due mainly to early recanalisation or improvement following tPA.

Median onset-to-puncture time was 245 minutes, IVT-to-puncture time was 51 minutes, and puncture to reperfusion time 43 minutes.

The study found bridging therapy was not associated with better functional outcome in the overall cohort (OR 0.96) using mRS 0-1 as the primary outcome.

However there was a strong interaction between the site of occlusion and the effect of bridging therapy.

“Bridging therapy was found very beneficial in proximal M1 occlusion (OR 3.26) and less beneficial in patients with distal M1 occlusion (OR 1.69) while bridging therapy was deleterious in patients with M2 occlusion (OR 0.53).”

In safety outcomes, bridging therapy was also associated with a higher odds of ICH in the overall cohort (OR 3.01).

“Here again we found an interaction between the site of occlusion and the effect of bridging therapy,” Dr Seners said.

Bridging therapy was associated with higher odds of ICH for M2 but not M1 occlusion.

Although the study was flagged as a highlight in the stroke section of the Congress, the observational data has yet to be confirmed in ongoing RCTs.

The study was published recently in Annals of Neurology.

In a related presentation, Dr Seners said the rate of early neurological deterioration in patients with minor stroke and large vessel occlusion treated with tPA alone was substantial.

Independent predictors of early neurological deterioration were more proximal occlusion and thrombus length ≥9mm which could help select the best candidates for immediate transfer for thrombectomy.

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