A Comparative Study On The Efficacy And Safety Of Direct Thrombectomy And Bridging In The Treatment Of Anterior Circulation AIS-LVO Within 4.5h

Objective: Intravenous thrombolysis(IVT)and Mechanical thrombectomy(MT)have become two main ways of treating Acute ischemic stroke(AIS).Currently,IVT within 4.5h is considered as an insurmountable scheme,and there are few studies on the efficacy and safety of direct mechanical thrombectomy within 4.5h.There is a controversy about whether direct thrombectomy can be performed.This paper aims to compare the efficacy and safety of direct thrombectomy within 4.5h and vessel bridging therapy,so as to explore the clinical application value of direct thrombectomy within 4.5h in the treatment of anterior circulation acute ischemic stroke with large vessel occlusion(AIS-LVO).Methods: Clinical data of 190 patients with acute ischemic stroke diagnosed with emergency thrombolysis admitted to sichuan provincial people's hospital,panzhihua central hospital,chengdu military region general hospital and shifang people's hospital from October 2013 to March 2018 were retrospectively analyzed.Patients were selected from 190 patients who were initiated with direct thrombectomy and bridging therapy within 4.5h,without IVT contraindications and anterior circulation great vessel occlusion,and were divided into the direct thrombectomy group and the bridging group.The National Institutes of Health Stroke Scale(The efficacy of the treatment was assessed by the NIHSS score,the difference between the NIHSS score before and after treatment,and the Modified Thrombolysis in Cerebral InfarctionScore(mTICI)after Thrombolysis,and the safety of the two treatment methods was compared by analyzing the Symptomatic intracranial hemorrhage(sICH),remote vascular occlusion,and 72 h mortality during hospitalization.Results: A total of 47 patients were selected,including 30 in the direct thrombectomy group and 17 in the bridging group,all of whom received conventional drug therapy after surgery.The comparison of baseline NIHSS score,age,gender and other factors between the two groups was comparable.Compared with the bridging group,there were fewer men(43.3% vs 64.7%,t= 1.984,P=0.159)in the direct thrombolysis group,and they were of the same age(64.27±12.52 vs 64.88±7.40,t=0.212,P=0.833).In the bridging group,there were 5 cases of internal carotid artery occlusion and 12 cases of middle cerebral artery M1/M2 occlusion.In the direct thrombectomy group,there were 12 cases of internal carotid artery occlusion and 18 cases of middle cerebral artery M1/M2 occlusion.Comparison of time from onset to admission between the two groups(149.07±57.62 min vs 128.76±50.378 min,t=1.212 P=0.232).There was no statistical difference.Meanwhile,there were no statistically significant differences between the two groups in the time from admission to femoral artery and the time from artery sheath to vascular recanalization.There was no statistical difference in NIHSS scores between the two groups 24 h before and after surgery.After 24 h of treatment,the NIHSS scores of the two groups were significantly decreased.According to t test analysis,t=9.067(P < 0.05)in the direct thrombolysis group and t= 6.237(P < 0.05)in the bridging group,showing significant statistical differences.There was no significant difference in effective vascular recanalization rate(mTICI blood flow grade was 2b/3),72-hour mortality rate,sICH rate during hospitalization,and distal vascular occlusion between the two groups.Conclusions: For ais-lvo before treatment,bridging therapy within 4.5h had no additional benefit compared with direct thrombectomy,which may be an alternative to bridging therapy.