To bridge or not to bridge: summary of the new evidence in endovascular stroke treatment

Stroke and Vascular Neurology

article

Anna Podlasek¹  Permesh Singh Dhillon²  Waleed Butt³  Iris Q Grunwald¹  Timothy J England⁵ 

[1] Tayside Innovation MedTech Ecosystem ,(TIME) , University of Dundee;NIHR Nottingham Biomedical Research Centre , University of Nottingham;Interventional Neuroradiology , Nottingham University Hospitals NHS Trust;Interventional Neuroradiology , University Hospitals Birmingham NHS Trust;Stroke, Division of Mental Health and Clinical Neurosciences, School of Medicine , University of Nottingham;Stroke , University Hospitals of Derby and Burton NHS Foundation Trust

关键词: thrombolysis;    stroke;    clinical trial;    thrombectomy;    cerebral infarction;   

DOI  :  10.1136/svn-2021-001465

学科分类：社会科学、人文和艺术（综合）

来源: BMJ Publishing Group

【 摘 要 】

Recently published summaries and metaanalyses of four randomised controlledtrials (RCTs)1–5 comparing direct mechanical thrombectomy (dMT) and bridgingtherapy with intravenous (IV) thrombolytics(alteplase) suggested that dMT is non-inferiorto bridging therapy to achieve good functionaloutcome 3months after stroke (modifiedRankin Score 0–2) with the non-inferioritymargin (NIM) <−5%.5–7 However, there wereconsiderable limitations in generalisabilityas three of the RCTs were performed in theAsian population, and the alteplase dosewas different between studies (0.6mg/kgor 0.9mg/kg). Recently, preliminary resultsof two further RCTs (SWIFT-DIRECT8 andDIRECT-SAFE9) were presented at the 2021World Stroke Congress and other conferences. Both RCTs (SWIFT-DIRECT andDIRECT-SAFE) compared dMT with bridgingtherapy, assuming a NIM of 12% and 10%,respectively. Both failed to confirm the noninferiority of dMT approach, although it isworth noting that DIRECT-SAFE was terminated early in June 2021, with only 293 out ofplanned 780 participants recruited, followingthe publications of the other RCTs’ results.

【 授权许可】

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