A comparative analysis of bridging therapy versus direct endovascular treatment in acute ischemic stroke patients aged 80 years and over / 中华老年医学杂志

ABSTRACT

Objective:To compare the safety and therapeutic effect of bridging therapy versus direct endovascular treatment in patients with acute ischemic stroke(AIS)aged 80 years and over, who received the therapy within 4.5 h of onset.Methods:A total of 89 AIS patients aged 80 years and over receiving the endovascular therapy at our hospital from January 2016 to June 2019 were studied with versus without intravenous thrombolysis before endovascular therapy(the former as bridging therapy group, n=49; the latter as the direct endovascular treatment group, n=40). Baseline information including gender, the modified Rankin scale(mRS)score, medical history, smoking history, preoperative national institute of health stroke scale(NIHSS)score were collected.Clinical data related to the operation including the times from onset to hospital, door-to-puncture and door-to-recanalization, complications(symptomatic cerebral hemorrhage, mortality)and mRS at 90 d after treatment were compared between the two groups.Multiple logistic regression analysis was used to determine whether or not bridging therapy with intravenous thrombolysis was a prognostic factor.Results:There was no significant difference in baseline information between the two groups( P>0.05). The times from onset to hospital, door-to-puncture, door-to-recanalization had no significant difference between the two groups( P>0.05). There was no significant difference in the incidence of symptomatic cerebral hemorrhage and mortality within 90 d between the two groups(26.5% or 13 cases vs. 17.5% or 7 cases, 14.3% or 7 cases vs.7.5% or 3 cases, χ2=1.031 and 1.017, P=0.310 and 0.313). With different clinical outcomes as dependent variables, after adjusting factors such as gender, admission NIHSS and medical history, Logistic regression analysis showed that the bridging therapy with intravenous thrombolysis was not a prognostic factor( OR=0.795, 95% CI 0.280~2.258, P=0.666). Conclusions:The bridging therapy is as safe and effective as the direct intravascular therapy for AIS patients aged 80 and over within 4.5 hours of onset.The intravenous thrombolysis should be given as soon as possible within time window.