Ischemic stroke patients treated with ‘bridging therapy’ within four-and-a-half-hours of their first symptoms may face better outcomes than those treated with mechanical thrombectomy alone.
The findings from the meta-analysis are published in the journal Neurology.
Two-step bridging therapy involves mechanical thrombectomy and the injection of a clot-busting drug.
Author Gabriela Trifan, MD, of the University of Illinois Chicago and a member of the American Academy of Neurology, said:
“For people with this kind of stroke, our analysis suggests that using clot-busting drug therapy combined with physical removal may be associated with better outcomes compared to treating people with physical removal of the clot only.
“We found that bridging therapy was also linked to better chances for more robust blood flow returning to the brain after stroke, and in turn, better functional independence for people after stroke.”
Researchers looked at 41 studies involving 14,885 people with large vessel occlusion strokes with an average age of 70.
Of those, 8,238 people were treated with bridging therapy and 6,647 were treated with clot removal alone.
Alteplase was used for the clot-busting treatment.
The bridging therapy patients were 29 per cent more likely to be able to live independently after three months.
Trifan said that this would translate to an additional 62 people out of 1000 who would be able to live without support with the two-step treatment verses thrombectomy alone.
The bridging therapy patients also 24 per cent higher odds of blood flow returning to the affected region of the brain and 31 per cent lower odds of dying 90 days after their stroke.
When the researchers restricted the analyses to the latest six high-quality randomised clinical trials, they found that functional independence and safety outcomes were similar between bringing therapy and clot removal alone.
The analysis does not prove that bridging therapy delivers better outcomes than thrombectomy alone, but it does show an association.
