Comparison of the Efficacy and Safety Between Intravenous Thrombolysis, Direct Endovascular Therapy, and Bridging Therapy for Acute Basilar Artery Occlusion in Cerebral Infarction Patients

Yuan Shen; Mingchao Li; ShuFang Wang; Lei Xia; Xiaoyu Ni; Li Zhou; Jianguo Zhong; Haicun Shi; Zhifeng Dong

doi:10.1016/j.wneu.2024.03.106

Comparison of the Efficacy and Safety Between Intravenous Thrombolysis, Direct Endovascular Therapy, and Bridging Therapy for Acute Basilar Artery Occlusion in Cerebral Infarction Patients

World Neurosurg. 2024 Mar 26:S1878-8750(24)00491-1. doi: 10.1016/j.wneu.2024.03.106. Online ahead of print.

Authors

Yuan Shen¹, Mingchao Li², ShuFang Wang¹, Lei Xia², Xiaoyu Ni², Li Zhou³, Jianguo Zhong¹, Haicun Shi¹, Zhifeng Dong⁴

Affiliations

¹ Department of Neurology, Affiliated Hospital 6 of Nantong University, Yancheng Third People's Hospital Affiliated to Jiangsu Vocational College of Medicine, Yancheng, China.
² Department of Neurology, Huai'an First Hospital Affiliated to Nanjing Medical University, Huai'an, China.
³ Department of Medical Service, Affiliated Hospital 6 of Nantong University, Yancheng Third People's Hospital Affiliated to Jiangsu Vocational College of Medicine, Yancheng, China.
⁴ Department of Cardiology, Affiliated Hospital 6 of Nantong University, Yancheng Third People's Hospital Affiliated to Jiangsu Vocational College of Medicine, Yancheng, China. Electronic address: zhifengdong6@126.com.

PMID: 38537790
DOI: 10.1016/j.wneu.2024.03.106

Abstract

Objective: To compare the efficacy and safety of intravenous thrombolysis, direct endovascular therapy (EVT), and bridging therapy (BT = intravenous thrombolysis + EVT) for acute basilar artery occlusion cerebral infarction.

Methods: One hundred and fourteen patients with acute basilar artery occlusion cerebral infarctions admitted between January 2020 and August 2023 were selected. Differences in the reperfusion rate, prognosis, incidence of stroke-associated pneumonia, and mortality rate were compared among the 3 groups.

Results: There was no statistically significant difference in the percentage of patients who achieved successful reperfusion (86.8% vs. 84.2%) or complete reperfusion (72.1% vs. 68.4%) between the direct EVT and BT groups (both P > 0.05). There were no statistically significant differences in the rates of symptomatic intracranial hemorrhage (3.7% vs. 10.3% vs. 10.5%, P = 0.763). There were statistically significant differences in the rates of good prognosis (modified ranking scale score 0-2) (59.3% vs. 30.9% vs. 26.3%, P = 0.021), stroke-related pneumonia (29.6% vs. 66.2% vs. 36.8%, P = 0.002), and mortality (14.8% vs. 48.5% vs. 42.1%, P = 0.010) among the 3 treatment groups. According to the binary logistic regression analysis, a good prognosis was independently associated with a baseline National Institutes of Health Stroke Scale score ≤ 10 (odds ratio, 3.714; 95% confidence interval, 1.207-11.430; P = 0.022) and the incidence of stroke-associated pneumonia (odds ratio, 0.640; 95% confidence interval, 0.484-0.845; P = 0.002).

Conclusions: Although there were differences in prognosis, mortality, and incidence of complications among the 3 treatment groups, after adjusting for confounding factors, prognosis was independently correlated only with the baseline NIHSS score and stroke-associated pneumonia but not with treatment methods.

Keywords: Acute basilar artery occlusion cerebral infarction; Bridging therapy; Direct endovascular treatment; Intravenous thrombolysis.