Comparison Of The Efficacy And Safety Of Direct Mechanical Thrombectomy And Bridging Therapy In The Treatment Of Acute Ischemic Stroke With Large Vessel Occlusion In Anterior Circulation

Objective: To compare of the efficacy and safety of direct mechanical thrombectomy(DMT)and bridging therapy(BT)in the treatment of acute ischemic stroke with large vessel occlusion(AIS-LVO)in anterior circulation.Methods:A total of 105 patients with AIS-LVO in anterior circulation who underwent mechanical thrombectomy(MT)in the Department of Neurolo-gy,Hebei General Hospital from January 2018 to October 2020 were selected in our study,of whom 62 were treated with DMT and 43 were treated with BT.Successful recanalization was evaluated by the modified treatment in cerebral infarction(m TICI),and the clinical outcomes of patients were evaluated by the modified Rankin Scale(m RS).The safety of treatment was assessed by operative complications,such as intracranial hemorrhage(ICH),and mortality rate.The baseline data,successful recanalization of blood vessels,symptomatic intracranial hemorrhage(s ICH)and other complications and clinical prognosis of the two groups were compared and analysed.Results:1.There were no significant differences bteween the group in the age,the proportion of gender,hypertension,diabetes,hyperlipidemia,atrial fibrillation,coronary heart disease,prestroke,and smoking history,the National institute of health stroke scale(NIHSS),the Alberta stroke pro-gram early CT score(ASPECTS),systolic blood pressure,blood sugar level,occlusion site,stroke etiology,and anesthesia methods(P>0.05);2.Compared with the BT group,the time from puncture to recanalization in the DMT group was significantly shorter[100(73.5,128.75)min vs120(102,135)min,P=0.003],and the number of thrombectomy was less [1(1,3)vs 2(2,3),P=0.014].There was no significant difference in the time from onset to admission and the time from puncture to reperfusion between the two groups,(P>0.05);3.After adjusting the factors that may have impacts on the clinical outcome,such as the time from puncture to vascular recanalization and the number of thrombectomy by using multivariate logistic regression analysis,there was no difference in the the rate of successful vascular reperfusion(88.7% vs 90.7%),90-day good prognosis(45.2% vs 51.2%),symptomatic intracranial hemorrhage(6.5% vs 11.6%)and 90 day mortality(11.3% vs14.0%)between the DMT and MT group(P>0.05).Conclusions:1.DMT and BT can both improve the clinical prognosis of patients with AIS-LVO in anterior circulation.2.For patients with anterior circulation AIS-LVO,DMT and BT have similar efficacy and safety.DMT may become an alternative treatment no less than BT for patients who are not suitable for or refuse intravenous thrombolysis.