Bridging or Direct Thrombectomy in Posterior Circulation Large-Vessel Occlusion Stroke: Analysis of Binational Registries and Meta-Analysis
Journal
Neurology
Journal Volume
105
Journal Issue
11
Start Page
e214353
ISSN
1526-632X
Date Issued
2025-12-09
Author(s)
Kim, Yong Soo
Chai, Chung Liang
Hsieh, Yi-Chen
Park, Jong-Moo
Lin, Chun-Jen
Kang, Kyusik
Sung, Pi-Shan
Lee, Soo Joo
Chen, Yu-Wei
Cha, Jae-Kwan
Lin, Kuan-Hung
Park, Tai Hwan
Tang, Chih-Wei
Lee, Kyungbok
Chu, Hai-Jui
Lee, Jun
Fu, Chuan-Hsiu
Hong, Keun-Sik
Chou, Chao-Liang
Yu, Kyung-Ho
Lin, Ching-Huang
Kim, Dong-Eog
Yen, Shang-Yih
Kim, Joon-Tae
Chen, Po-Lin
Choi, Jay Chol
Chung, Chih-Ping
Kwon, Jee-Hyun
Shin, Dong-Ick
Sohn, Sung-Il
Chiou, Hung Yi
Kim, Chulho
Park, Kwang-Yeol
Kim, Chi Kyung
Lien, Li-Ming
Heo, Sung Hyuk
Lee, Jiunn-Tay
Chan, Lung
Kim, Beom Joon
Bae, Hee-Joon
Abstract
The role of IV thrombolysis before endovascular thrombectomy (bridging thrombectomy, BT) in posterior circulation large-vessel occlusion stroke remains uncertain. This study evaluated the effectiveness and safety of BT compared with direct thrombectomy (DT) using data from 2 nationwide registries and an updated meta-analysis. Patients from collaborative registries in Taiwan and South Korea who underwent thrombectomy for vertebral, basilar, and posterior cerebral artery occlusions were included. This observational study included hospital-based registry data with standardized collection of treatments and outcomes. Propensity score matching was applied to adjust for baseline differences between BT and DT groups. Outcomes included 90-day modified Rankin Scale (mRS) score, mortality, successful reperfusion, and symptomatic intracranial hemorrhage (sICH). We also performed a systematic review and meta-analysis of observational studies comparing BT vs DT in posterior circulation large-vessel occlusion stroke. Among the combined 9,942 patients, 873 (median age 71, 32% female) who underwent thrombectomy for posterior circulation stroke were analyzed. Of them, 281 received BT and 592 received DT. BT was associated with a lower 90-day mRS score (median 3 vs 4; adjusted odds ratio [OR] 1.44 per 1-point improvement, 95% CI 1.09-1.91) and lower mortality (17.4% vs 26.9%; adjusted OR 0.51, 95% CI 0.33-0.81). The proportions of successful reperfusion (79.3% vs 81.1%) and sICH (2.5% vs 2.9%) were comparable. In propensity score-matched cohorts (n = 205 each), BT remained associated with better functional outcomes (OR 1.44, 95% CI 1.00-2.07) and reduced mortality (matched OR 0.45, 95% CI 0.26-0.78). The meta-analysis, which included 39 studies and 7,288 patients, confirmed that BT was associated with higher odds of achieving 90-day mRS score 0-2 (OR 1.57, 95% CI 1.28-1.94), 90-day mRS score 0-3 (OR 1.33, 95% CI 1.05-1.68), and lower mortality (OR 0.77, 95% CI 0.61-0.97), without an increased risk of sICH (OR 1.01, 95% CI 0.71-1.44). BT was associated with better 90-day functional outcomes and lower mortality, without increasing hemorrhagic risk in posterior circulation large-vessel occlusion stroke. These findings support the use of BT in eligible patients, pending further validation from randomized trials. This study provides Class III evidence that in patients with posterior circulation stroke undergoing thrombectomy, previous IV thrombolysis is associated with better 90-day functional outcomes and lower mortality without increasing hemorrhagic risk.
Type
journal article