Impact of Strategy on Clinical Outcome in Large Vessel Occlusion Stroke Successfully Reperfused: ETIS Registry Results
Authors: Douarinou Marian , Gory Benjamin , Consoli Arturo , Lapergue Bertrand , Kyheng Maeva , Labreuche Julien , Anadani Mohammad , Blanc Raphael , Marnat Gaultier , Bourcier Romain , Sibon Igor , Eugène François , Vannier Stéphane , Audibert Gérard , Mione Gioia , Richard Sébastien , Piotin Michel , Redjem Hocine , Escalard Simon , Dessilles Jean-Philippe , Delvoye François , Smajda Stanislas , Maier Benjamin , Solène Hebert , Mazighi Mikael , Obadia Mikael , Sabben Candice , Pierre Seners , Igor Raynouard , Corabianu Ovide , Broucker Thomas de , Manchon Eric , Taylor Guillaume , Maacha Malek Ben , Thion Laurie-Anne , Augustin Lecler , Julien Savatovsjy , Wang Adrien , Evrard Serge , Tchikviladze Maya , Ajili Nadia , WeisenburgerLile David , Gorza Lucas , Buard Géraldine , Coskun Oguzhan , Di Maria Federico , Rodesh Georges , Zimatore Sergio , Leguen Morgan , Gratieux Julie , Pico Fernando , Rakotoharinandrasana Haja , Tassan Philippe , Poll Roxanna , Marinier Sylvie , Gariel Florent , Barreau Xavier , Berge Jérôme , Menegon Patrice , Lucas Ludovic , Olindo Stéphane , Renou Pauline , Sagnier Sharmila , Poli Mathilde , Debruxelles Sabrina , Rouanet François , Tourdias Thomas , Liegey Jean-Sebastien , Briau Pierre , Pangon Nicolas , Detraz Lili , Daumas-Duport Benjamin , Alexandre Pierre-Louis , Roy Monica , Lenoble Cédric , Desal Hubert , Guillon Benoît , Gaalon Solène de , Preterre Cécile , Bracard Serge , Anxionnat René , Braun Marc , Derelle Anne-Laure , Tonnelet Romain , Liao Liang , Zhu François , Schmitt Emmanuelle , Planel Sophie , Humbertjean Lisa , Lacour Jean-Christophe , Riou- Comte Nolwenn , Voicu Marcela , Alb Lionel , Reitter Marie , Brezeanu Madalina , Masson Agnès , Tabarna Adriana , Podar Iona , Macian-Montoro Francisco , Saleme Suzanna , Mounayer Charbel , Rouchaud Aymeric , Costalat Vincent , Arquizan Caroline , Dargazanli Cyril , Gascou Grégory , Lefèvre Pierre-Henri , Derraz Imad , Riquelme Carlos , Gaillard Nicolas , Mourand Isabelle , Corti Lucas , Cagnazzo Federico , Schiphorst Adrien ter , Ferre Jean-Christophe , Raoult Hélène , Ronziere Thomas , Lassale Maria , Paya Christophe , Gauvrit Jean-Yves , Tracol Clément , Langnier-Lemercier Sophie 
Published: November 2021

Background and Purpose:
Approximately half of the patients with acute ischemic stroke due to anterior circulation large vessel occlusion do not achieve functional independence despite successful reperfusion. We aimed to determine influence of reperfusion strategy (bridging therapy, intravenous thrombolysis alone, or mechanical thrombectomy alone) on clinical outcomes in this population.

Methods:
From ongoing, prospective, multicenter, observational Endovascular Treatment in Ischemic Stroke registry in France, all patients with anterior circulation large vessel occlusion who achieved successful reperfusion (modified Thrombolysis in Cerebral Infarction 2b-3) following reperfusion therapy were included. Primary end point was favorable outcome, defined as 90-day modified Rankin Scale score ≤2. Patient groups were compared using those treated with bridging therapy as reference. Differences in baseline characteristics were reduced after propensity score-matching, with a maximum absolute standardized difference of 14% for occlusion site.

Results:
Among 1872 patients included, 970 (51.8%) received bridging therapy, 128 (6.8%) received intravenous thrombolysis alone, and the remaining 774 (41.4%) received MT alone. The rate of favorable outcome was comparable between groups. Excellent outcome (90-day modified Rankin Scale score 0–1) was achieved more frequently in the bridging therapy group compared with the MT alone (odds ratio after propensity score-matching, 0.70 [95% CI, 0.50–0.96]). Regarding safety outcomes, hemorrhagic complications were similar between the groups, but 90-day mortality was significantly higher in the MT alone group compared with the bridging therapy group (odds ratio, 1.60 [95% CI, 1.09–2.37]).

Conclusions:
This real-world observational study of patients with anterior circulation large vessel occlusion demonstrated a similar rate of favorable outcome following successful reperfusion with different therapeutic strategies. However, our results suggest that bridging therapy compared with MT alone is significantly associated with excellent clinical outcome and lower mortality.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03776877.