‘Bridging’ Solution Shows Promise for Stroke Patients

By Jonathan Springston, Editor, Relias Media

When treating ischemic stroke, of two leading treatments, clinicians might choose only one course; however, the results of a new meta-analysis suggest using both together could improve odds for survival and better quality of life.

For ischemic stroke patients, depending on the circumstances, clinicians might pick intravenous thrombolysis (injecting clot-busting drugs) or choose to perform a minimally invasive procedure called mechanical thrombectomy (removing the blood clot through a small incision). Using both concurrently is referred to as “bridging therapy.” Investigators wanted to learn more about what could be the best approach: thrombectomy alone or bridging therapy.

The authors conducted a literature review, uncovering 41 studies that included more than 14,000 patients with large vessel occlusion strokes (average age = 70 years). Of those, more than 8,200 had undergone bridging therapy, while more than 6,600 had undergone thrombectomy alone. Specifically, the researchers were looking closely at functional independence (modified Rankin Scale score 0-2), 90-day mortality rates, symptomatic hemorrhage, and successful recanalization rate.

Generally, bridging therapy translated to 31% lower odds of dying within 90 days and 29% higher odds of living independently after 90 days. Because of the nature of this study design, the investigators did not prove definitively bridging therapy is the best course. Notably, when the authors looked at only the six randomized clinical trials, the differences between bridging therapy and thrombectomy alone were much less noticeable.

“While these results are not strong enough to change practice at this time, they constitute a step forward into the concept of individualized medicine, where for selected patients in the appropriate clinical settings, clot removal may be as efficient and safe as bridging therapy,” said study co-author Gabriela Trifan, MD.

For more on this and related subjects, be sure to read the latest issues of ED Management, Emergency Medicine Reports, and Neurology Alert. For even more on stroke research, be sure to check out Stroke 2022: Advances in Treatment and Care.