• Bin Qin, Tao Wei, Wen Gao, Hui-Xun Qin, Yu-Ming Liang, Cheng Qin, Hong Chen, and Ming-Xiu Yang.
• Department of Neurology, Liuzhou People's Hospital, Liuzhou, Guangxi, China; Liuzhou Key Laboratory of Epilepsy Prevention and Research, Liuzhou, Guangxi, China; Department of Neurology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China.
• Clinics (Sao Paulo). 2024 Jan 1; 79: 100394100394.

Background And PurposeIntravenous Thrombolysis (IVT) prior to Mechanical Thrombectomy (MT) for Acute Ischaemic Stroke (AIS) due to Large-Vessel Occlusion (LVO) remains controversial. Therefore, the authors performed a meta-analysis of the available real-world evidence focusing on the efficacy and safety of Bridging Therapy (BT) compared with direct MT in patients with AIS due to LVO.MethodsFour databases were searched until 01 February 2023. Retrospective and prospective studies from nationwide or health organization registry databases that compared the clinical outcomes of BT and direct MT were included. Odds Ratios (ORs) and 95 % Confidence Intervals (CIs) for efficacy and safety outcomes were pooled using a random-effects model.ResultsOf the 12 studies, 86,695 patients were included. In patients with AIS due to LVO, BT group was associated with higher odds of achieving excellent functional outcome (modified Rankin Scale score 0-1) at 90 days (OR = 1.48, 95 % CI 1.25-1.75), favorable discharge disposition (to the home with or without services) (OR = 1.33, 95 % CI 1.29-1.38), and decreased mortality at 90 days (OR = 0.62, 95 % CI 0.56-0.70), as compared with the direct MT group. In addition, the risk of symptomatic intracranial hemorrhage did not increase significantly in the BT group.ConclusionThe present meta-analysis indicates that BT was associated with favorable outcomes in patients with AIS due to LVO. These findings support the current practice in a real-world setting and strengthen their validity. For patients eligible for both IVT and MT, BT remains the standard treatment until more data are available.Copyright © 2024 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.

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