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Bridging therapy improves functional outcomes and reduces 90-day mortality compared with direct endovascular thrombectomy in patients with acute posterior ischemic stroke: a systematic review and meta-analysis

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Abstract

Background

It remains unclear whether bridging therapy can achieve better neurologic outcomes than direct endovascular thrombectomy (EVT) in patients with posterior ischemic stroke.

Methods

We systematically searched PubMed, EMBASE, and Cochrane databases with posterior artery occlusion treated with bridging therapy vs. EVT. Efficacy was assessed based on functional independence at 90 days and successful recanalization, whereas safety was assessed by mortality, rate of symptomatic intracranial hemorrhage (sICH), and occurrence of any hemorrhage. All data were analyzed with Review Manager software v5.3 and the risk of bias was determined using the Methodological Index for Non-randomized Studies.

Results

We included 17 studies with a total of 3278 patients (1211 in the bridging therapy group and 2067 in the EVT group). Patients in the bridging group had a better functional outcome at 90 days, as evidenced by a higher proportion with a Modified Rankin Scale (mRS) score of 0–2 compared with the EVT group (odds ratio (OR) = 1.83, 95% confidence interval (CI): 1.54–2.19, P < 0.01), while no difference in mRS score of 0–3 (OR = 1.18, 95% CI: 0.96–1.45, P = 0.11). Patients in the bridging therapy group also had lower 90-day mortality rate (OR = 0.75, 95% CI: 0.59–0.95, P = 0.02). There were no significant differences between groups in rates of successful recanalization (OR = 0.96, 95% CI: 0.74–1.25, P = 0.77), sICH (OR = 1.27, 95% CI: 0.86–1.89, P = 0.24), and hemorrhage (OR = 1.22, 95% CI: 0.60–2.50, P = 0.58).

Conclusions

Among patients with posterior ischemic stroke, bridging therapy may be superior to EVT in achieving a good functional outcome and lowering the mortality without increasing the risks of hemorrhage.

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Data availability

All data for this study are available in the article and in the Supplemental Materials.

Abbreviations

EVT:

Endovascular thrombectomy

IVT:

Intravenous thrombolysis

mTICI:

Modified Thrombolysis in Cerebral Infarction

mRS:

Modified Rankin Scale

sICH:

Symptomatic intracranial hemorrhage

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Acknowledgements

We appreciate the valuable and constructive suggestions and assistance from our Team of Neurosurgical study.

Funding

This work was supported by the Natural Science Foundation of Jiangsu Province (Grant No. BK20200203) and the National Natural Science Foundation of China (Grant No. 82171309).

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  1. Huiru Chen and Youjia Qiu contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China

    Huiru Chen, Youjia Qiu, Zilan Wang, Zhouqing Chen & Zhong Wang

  2. Department of Neurology, The First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu Province, China

    Huiru Chen & Yan Kong

  3. Suzhou Medical College of Soochow University, Suzhou, 215002, Jiangsu Province, China

    Haiying Teng

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Contributions

HRC, YJQ, and ZLW were the principal investigators. ZW and KY designed the study and developed the analysis plan; HRC, YJQ, and ZLW analyzed the data and performed the meta-analysis; HRC and YJQ contributed to the writing of the article. XYY, HYT, and ZQC revised the manuscript and polished the language. All authors read and approved the final submitted paper.

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Correspondence to Zhouqing Chen, Yan Kong or Zhong Wang.

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Chen, H., Qiu, Y., Wang, Z. et al. Bridging therapy improves functional outcomes and reduces 90-day mortality compared with direct endovascular thrombectomy in patients with acute posterior ischemic stroke: a systematic review and meta-analysis. Neurol Sci 45, 495–506 (2024). https://doi.org/10.1007/s10072-023-07096-x

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