Comparative Analysis On The Efficacy Of Bridging Therapy And Pure Intravenous Thrombolysis In Patients With Posterior Circulation Ischemia Stroke

Objective:Discuss the efficacy comparison of bridging therapy and pure intravenous thrombolysis in patients with acute posterior circulation ischemia stroke.Methods:Retrospective analysis was conducted on 88 patients with acute posterior circulation ischemia stroke caused by macrovascular occlusion who were treated in Cangzhou Central Hospital from March 2016 to December 2019,including 42 patients in the bridging therapy group and 46 patients in the intravenous thrombolysis group.Patients in the intravenous thrombolysis group were treated with pure recombinant tissue plasminogen activator（rt-PA）,and patients in the bridging therapy group were treated with blood vessels recanalization within the time window for intravascular therapy after intravenous thrombolysis.Baseline data and relevant risk factors were collected for all patients.NIHSS score assessments were conducted before treatment,after 24 hours of treatment,and after 7 days of treatment.Revascularization was judged by m TICI scores within 72 hours of treatment.Modified Rankin scale（m RS）score assessment were before treatment and at the 90th day of treatment.After treatment,comparisons were made between the two groups in short-term neural functions,the long-term independence,the rate of good prognosis,the rate of post-treatment complications,the revascularization rate and the mortality rate after treatment.Results:1.More patients with atrial fibrillation were observed in the bridging therapy group compared with the intravenous thrombolysis group（30.95%vs8.69%,P=0.008）despite that fact that there is no apparent difference between the two groups in other baseline data and risk factors related to brain stoke;2.There is no significant between the two groups in admission NIHSS scores and m RS scores（P>0.05 for both）,and those scores apparently lowered 24 hours after treatments（P<0.05 for both）.The bridging therapy group had more visible changes in NIHSS during the first 7 days of treatment（8vs6.5,P=0.037）,and had even lower NIHSS score at the 7^thday（6vs12,P=0.022）.More patients with m RS0～2 score were found at the 90^thday of treatment（57.14%vs34.78%,P=0.035）.The comparison of the two groups has statistical significance;3.Head and neck MRA,CTA or DSA is adopted to assess the vascular conditions of all patients within 72 hours of treatment.The bridging therapy group had 38 cases with successful revascularization,recording a revascularization rate of 90.47%.The intravenous thrombolysis group totally had 18 cases with satisfactory revascularization,a revascularization rate of 39.13%,the comparison of the two groups has statistical significance（P<0.001）;4.Totally 7 patients died,but there is no significant difference between the two groups in mortality rate.After treatment,there is no significant difference between the two groups in the incidence of cerebral hemorrhage,the incidence of residual complications,and the incidence of overall complications（P>0.05 for both）.Conclusions:1.Both therapies have efficacy in the treatment of patients with posterior circulation ischemia stroke.2.The bridging therapy has a better efficacy in the short-term neural function recovery and the long-term independence recovery of patients.3.The bridging therapy is more likely to increase the revascularization rate.4.The therapies are basically comparable in the incidence of cerebral hemorrhage,the incidence of other complications,and the mortality rate.