Comparative Study Of Efficacy And Safety Of Direct Endovascular Treatment And Bridging Therapy For Acute Large-vessel Occlusion In Anterior Circulation Stroke

Objective To compare the efficacy and safety of direct thrombectomy and bridging therapy for acute large-vessel occlusion in anterior circulation stroke.Methods A retrospective study was performed on clinical data of 112 patients with anterior circulation large-vessel occlusion stroke who accepted thrombectomy in China-Japan Union hospital of Jilin University from September 2017 to September 2019;43 patients were in direct endovascular treatment(DEVT)group and 69 patients were in bridging therapy(BT)group.The clinical characteristics,procedural complications and clinical outcomes between the two groups were compared.Results There were no significant differences between the two groups in gender,baseline National Institutes of Health Stroke Scale(NIHSS)scores,percentages of patients with hypertension,diabetes and coronary heart disease,baseline blood glucose,platelet count,baseline neutrophil ratio,baseline systolic blood pressure,stroke etiology,smoking and drinking history,ASPECTS score before treatment,puncture-to-re-canalization time,admission-to-re-canalization time,time of thrombectomy and anesthesia methods in DEVT group compared with BT group(p>0.05),while there are significant differences in age,atrial fibr illation,onset-to-admission time and admission-to-puncture time(p<0.05).After Logistic regression model was used to adjust factors such as age,atrial fibrillation,time from onset to admission,and time from admission to puncture,which may affect clinical outcomes,the successful reperfusion rate(90.7% vs.92.7%),incidence of symptomatic intracranial hemorrhage(14.0 % vs.21.7%),favorable outcome rate 90 d after treatment(16.5% vs.52.5%),and mortality(16.3% vs.11.6%)were not significantly different between the two groups(p>0.05).Conclusion The efficacy and safety of direct thrombectomy and bridging therapy are similar for acute large-vessel occlusion in anterior circulation stroke,but this conclusion needs to be further clarified by high-level evidence-based medicine.