Does 'bridging' therapy improve outcome for people with stroke?
Meta-analysis finds clot-busting drug followed by clot removal works best


Date:
February 16, 2022
Source:
American Academy of Neurology
Summary:
There has been debate over the best treatment for a certain type of
stroke caused by a blockage of a large artery in the brain. A new
meta- analysis finds that people who have this kind of stroke who
can be treated within four-and-a-half hours after their symptoms
start may do better after their stroke when treated with both a
clot-busting drug and physical clot removal, compared to physical
removal only. Combining the two therapies, called bridging therapy,
was linked to better chances of a person surviving and living
independently after stroke.



FULL STORY ========================================================================== There has been debate over the best treatment for a certain type
of stroke caused by a blockage of a large artery in the brain. A new meta-analysis finds that people who have this kind of stroke who can be
treated within four-and-a- half hours after their symptoms start may do
better after their stroke when treated with both a clot-busting drug and physical clot removal, compared to physical removal only. The research
is published in the February 16, 2022, online issue of Neurology(R),
the medical journal of the American Academy of Neurology. Combining the
two therapies, called bridging therapy, was linked to better chances of
a person surviving and living independently after stroke.


==========================================================================
The most common type of stroke is an ischemic stroke, occurring when
a vessel supplying blood to the brain is blocked. When the blockage is
in a major artery, it is called a large vessel occlusion stroke. Large
vessel occlusions of the anterior circulation, which were examined in
this study, occur in the front of the brain and are a leading cause of
adult disability.

Two-step bridging therapy involves the following: intravenous
thrombolysis, injecting clot-busting drugs; and mechanical thrombectomy,
a minimally invasive procedure in which the blood clot is removed through
a small incision.

"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," said meta-analysis author Gabriela Trifan, MD,
of the University of Illinois Chicago and a member of the American Academy
of Neurology. "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."
For the meta-analysis, 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. The drug alteplase was used for the clot-busting therapy.

Researchers found that people who had bridging therapy had 29% higher
odds of being able to live independently after three months. Trifan said
that would translate into an anticipated additional 62 people out of every 1,000 people who would be able to live independently with bridging therapy versus clot removal alone. The people receiving bridging therapy also
had 24% higher odds of blood flow returning to the parts of their brain affected by stroke compared to people who had clot removal alone, which translated into an anticipated 34 additional people out of every 1,000.

People who had bridging therapy also had 31% lower odds of dying 90 days
after their stroke compared to people who had clot removal alone. Trifan
said this would translate to an anticipated 59 fewer deaths per 1,000
people.

When the researchers restricted the analyses to the latest six
high-quality randomized clinical trials, they found that functional independence and safety outcomes were similar between bringing therapy
and clot removal alone. "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 Trifan.

The meta-analysis does not prove that people with this type of stroke
will have better outcomes when treated with both therapies; it only
shows an association.

"This meta-analysis demonstrates that bridging therapy is safe and does
not increase the risk of hemorrhage or delay the start of clot removal,"
Trifan said.

A limitation of the meta-analysis is that alteplase was the only drug
allowed in this analysis. In addition, the results are only applicable
to people who go to medical centers that provide thrombectomy.

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dreams in this free online course from New Scientist -- Sign_up_now_>>> ========================================================================== Story Source: Materials provided by American_Academy_of_Neurology. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Gabriela Trifan, Jose Biller, Fernando D. Testai. Mechanical
Thrombectomy
vs Bridging Therapy for Anterior Circulation Large Vessel Occlusion
Stroke: Systematic Review and Meta-analysis. Neurology, 2022 DOI:
10.1212/WNL.0000000000200029 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/02/220216162303.htm

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