Functional and radiological outcomes after bridging therapy versus direct thrombectomy in stroke patients with unknown onset.

BACKGROUND We aimed to assess functional and radiological outcomes after bridging therapy (intravenous thrombolysis plus mechanical thrombectomy, MT) vs direct MT in unknown onset stroke patients. METHODS We conducted a cohort study on prospectively collected data from unknown onset stroke patients who received endovascular procedures ≤6 hours from symptom recognition or awakening time. RESULTS Of the 349 patients with 10-Point ASPECTS, 248 received bridging and 101 received direct MT. Of the 134 patients with 6-9-Point ASPECTS, 123 received bridging and 111 received direct MT. Each patient treated with bridging was propensity score matched with a patient treated with direct MT for age, sex, study period, pre-stroke disability, stroke severity, type of stroke onset, symptom recognition (or awakening)-to-groin time, ASPECTS, and procedure time. In the two matched groups with 10-Point ASPECTS (n=73 vs n=73), bridging was associated with higher rates of excellent outcome (46.6% vs 28.8%; OR: 2.302, 95% CI: 1.010-5.244) and successful recanalization (83.6% vs 63%; OR: 3.028, 95% CI: 1.369-6.693) compared with direct MT; no significant association were found between bridging and direct MT as regards rate of sICH (0 vs 1.4%). In the two matched groups with 6-9-Point ASPECTS (n=45 vs n=45), no significant associations were found between bridging and direct MT as regards rates of excellent functional outcome (44.4% vs 31.1%), successful recanalization (73.3% vs 76.5%), and sICH (0 vs 0). CONCLUSIONS Bridging ≤6 hours of symptom recognition or awakening time was associated with better functional and radiological outcomes in unknown onset stroke patients with 10-Point ASPECTS.