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Abstract 023: Direct Endovascular Treatment versus Bridging Therapy for Acute Ischemic Stroke Due to Isolated Distal Medium Vessel Occlusions: A Multicenter Study of 365 Patients
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Abstract 023: Direct Endovascular Treatment versus Bridging Therapy for Acute Ischemic Stroke Due to Isolated Distal Medium Vessel Occlusions: A Multicenter Study of 365 Patients

M Doheim, M Mohammaden, H Abdelhamid, S Matsoukas, B Schuldt, J Fifi, O Kuybu, A Al-Bayati, M Olive-Gadea, M Rodrigo-Gisbert, …
Stroke: vascular and interventional neurology, Vol.4(S1)
11/01/2024
DOI: 10.1161/SVIN.04.suppl_1.023
PMCID: PMC12773845
url
https://doi.org/10.1161/SVIN.04.suppl_1.023View
Published (Version of record) Open Access

Abstract

Background and purposeThe optimal recanalization strategy for patients presenting with acute ischemic stroke due to distal medium vessel occlusions (DMVOs) remains uncertain. This multicenter study compared the safety and efficacy of bridging therapy (intravenous thrombolysis [IVT] followed by endovascular thrombectomy [EVT]) versus EVT alone in these patients.MethodsWe collected data from 14 comprehensive stroke centers in the USA. Isolated DMVO patients treated using EVT with or without IVT were included. Patients were included if they had DMVO due to middle cerebral artery (MCA)‐M3/4, anterior cerebral artery (ACA)‐A1/A2‐3, or posterior cerebral artery (PCA)‐P1/P2‐3 and underwent EVT within 24 hours from time since last known well to puncture. The primary outcome was the shift in the degree of disability as measured by the 90‐day modified Rankin Score (mRS). Secondary outcomes included successful reperfusion, excellent (mRS0‐1), and good outcomes (mRS0‐2) at 90‐days. Safety measures included symptomatic intracerebral hemorrhage (sICH) and 90‐day mortality. Mixed binary and ordinal logistic regression were used to estimate outcomes after adjusting for baseline imbalances.ResultsAmong screened records of 907 patients with DMVOs, 365 patients with isolated DMVOs (137 in the bridging group and 228 in the EVT alone) were included in the final analysis. Despite being late presenters (median [IQR] time from last known well (LKW) to puncture (527.5 [256.5‐832.5] vs. 234 [186‐330] minutes, p<0.001), EVT group had comparable outcomes to bridging therapy in the overall degree of disability (mRS ordinal shift, adjusted common OR 1.29, 95% CI [0.80‐2.00], P=0.31, Figure 1), and rates of 90‐day good (mRS score 0‐2: 88/211 (41.7) vs. 64/123 (52.0), aOR1.44 95% CI [0.81‐2.55], P=0.21). The rates of sICH (14/221 (6.3) vs. 9/130 (6.9), aOR 1.02 95% CI [0.39‐2.67], P=0.97) and 90‐day mortality (53/211 (25.1) vs. 26/123 (21.1), aOR 0.64 95% CI [0.33,1.24], P=0.19) were comparable between EVT and birding therapy groups.ConclusionIn patients presenting with DMVOs, both bridging and EVT alone strategies were comparable for safety and efficacy outcomes. Prospective randomized controlled trials stratifying “drip and ship” transferred vs mothership cases, including IVT alone arm, and assessing the cost‐effectiveness of both strategies are highly encouraged.
 Ischemia Stroke Veins & arteries

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