Bridging with intravenous thrombolysis versus direct endovascular thrombectomy for acute ischemic stroke

Abstract

The disability and mortality of acute ischemic stroke are very high, which brings great burden to family and society. Timely and effective vascular recanalization is possible to make a good prognosis for patients. Since 2008, the intravenous thrombolytic therapy for patients with acute ischemic stroke within the time window has become the recommended treatment scheme of the guidelines in different countries. However, intravenous thrombolysis has the disadvantages of low vascular recanalization rate, narrow treatment time window, and relatively more contraindications, which limits its clinical application. In recent years, with the appearance of stent-like thrombectomy devices, mechanical thrombectomy within the time window has gradually become the mainstream treatment scheme for acute ischemic stroke. The latest guidelines for stroke treatment recommend the use of intravenous thrombolytic bridging endovascular thrombectomy within the time window. However, it is still unclear whether intravenous thrombolysis will increase the rate of vascular recanalization, improve clinical outcome, and increase the risk of intracranial hemorrhage before thrombectomy. This article reviews the vascular recanalization rate, clinical outcome, and intracranial hemorrhage risk of bridging therapy and direct mechanical thrombectomy. Key words: Stroke; Brain Ischemia; Thrombolytic Therapy; Endovascular Procedures; Thrombectomy; Treatment Outcome; Intracranial Hemorrhages