@article{e0d62853c9dd48f98f4b652805fe64e7,
title = "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: European Journal of Neurology",
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. {\textcopyright} 2020 European Academy of Neurology",
keywords = "ASPECTS, stroke, thrombectomy, thrombolysis, unknown onset, fibrinolytic agent, aged, Article, brain hematoma, brain hemorrhage, brain ischemia, clinical outcome, cohort analysis, collateral circulation, computer assisted tomography, diabetes mellitus, female, fibrinolytic therapy, functional status, general anesthesia, human, internal carotid artery occlusion, major clinical study, male, mechanical thrombectomy, middle cerebral artery occlusion, multicenter study, National Institutes of Health Stroke Scale, nuclear magnetic resonance imaging, onset age, petechia, priority journal, prospective study, Rankin scale, recanalization, stroke patient, symptom",
author = "M. Cappellari and V. Saia and G. Pracucci and F. Sallustio and R. Gandini and S. Nappini and P. Nencini and S. Vallone and A. Zini and G. Bigliardi and F. Granata and F. Grillo and S. Cioni and R. Tassi and M. Bergui and P. Cerrato and A. Saletti and {De Vito}, A. and R. Gasparotti and M. Magoni and F. Taglialatela and M. Ruggiero and M. Longoni and L. Castellan and L. Malfatto and R. Menozzi and P. Castellini and M. Cosottini and M. Mancuso and A. Comai and E. Franchini and E. Lozupone and {Della Marca}, G. and E.F.M. Ciceri and B. Bonetti and P. Zampieri and D. Inzitari and S. Mangiafico and D. Toni",
note = "Export Date: 9 February 2021 CODEN: EJNEF Correspondence Address: Cappellari, M.; Azienda Ospedaliera Universitaria IntegrataItaly; email: manuel_cappellari@libero.it References: Goyal, M., Menon, B.K., van Zwam, W.H., Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials (2016) Lancet, 387, pp. 1723-1731; Powers, W.J., Rabinstein, A.A., Ackerson, T., 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association (2018) Stroke, 49, pp. e46-e110; Toni, D., Mangiafico, S., Agostoni, E., Intravenous thrombolysis and intra-arterial interventions in acute ischemic stroke: Italian Stroke Organisation (ISO)-SPREAD guidelines (2015) Int J Stroke, 10, pp. 1119-1129; Albers, G.W., Marks, M.P., Kemp, S., Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging (2018) N Engl J Med, 378, pp. 708-718; Nogueira, R.G., Jadhav, A.P., Haussen, D.C., Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct (2018) N Engl J Med, 378, pp. 11-21; Thomalla, G., Simonsen, C.Z., Boutitie, F., MRI-guided thrombolysis for stroke with unknown time of onset (2018) N Engl J Med, 379, pp. 611-622; Ma, H., Campbell, B.C.V., Parsons, M.W., Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke (2019) N Engl J Med, 380, pp. 1795-1803; Association between brain imaging signs, early and late outcomes, and response to intravenous alteplase after acute ischaemic stroke in the third International Stroke Trial (IST-3): secondary analysis of a randomised controlled trial (2015) Lancet Neurol, 14, pp. 485-496; Armona, C., Wainsteina, J., Goura, A., CT-guided thrombolytic treatment of patients with wake-up strokes (2019) eNeurologicalSci, 14, pp. 91-97; Mourand, I., Milhaud, D., Arquizan, X.C., Favorable bridging therapy based on DWI-FLAIR mismatch in patients with unclear-onset stroke (2016) AJNR Am J Neuroradiol, 37, pp. 88-93; Mistry, E.A., Mistry, A.M., Nakawah, M.O., Mechanical thrombectomy outcomes with and without intravenous thrombolysis in stroke patients: a meta-analysis (2017) Stroke, 48, pp. 2450-2456; Yang, P., Zhang, Y., Zhang, L., Endovascular thrombectomy with or without intravenous alteplase in acute stroke N Engl J Med, 382, pp. 1981-1993; Olive-Gadea, M., Martins, N., Boned, S., Baseline ASPECTS and e-ASPECTS correlation with infarct volume and functional outcome in patients undergoing mechanical thrombectomy (2019) Neuroimaging, 29, pp. 198-202; Desai, S.M., Tonetti, D.A., Molyneaux, B.J., Interaction between time, ASPECTS, and clinical mismatch (2020) J Neurointerv Surg, 12, pp. 911-914",
year = "2021",
doi = "10.1111/ene.14529",
language = "English",
volume = "28",
pages = "209--219",
journal = "Eur. J. Neurol.",
issn = "1351-5101",
publisher = "Blackwell Publishing Ltd",
number = "1",
}