Abstract
OBJECTIVE: To compare the clinical and procedural outcomes, as well as complication rates, between bridging therapy (BT) and direct mechanical thrombectomy (D-MT) in patients with acute ischemic stroke (AIS) due to anterior circulation large vessel occlusion (LVO). METHODS: In this retrospective cohort study, 169 patients who underwent endovascular therapy (EVT) between January 2021 and January 2024 were included. Patients were divided into a BT group (n=96, intravenous alteplase followed by thrombectomy) and a D-MT group (n=73, thrombectomy alone). Baseline characteristics, procedural data, and 90-day functional outcomes were compared. Multivariable logistic regression identified predictors of 90-day favorable outcome (modified Rankin Scale score 0-2). RESULTS: Baseline characteristics were balanced between the groups (all P>0.05). The BT group showed a numerically higher rate of 90-day favorable functional outcome (56.25% vs. 46.58%, P=0.212) and lower mortality rate (4.17% vs. 10.96%, P=0.089), but differences were not statistically significant. Recanalization rates (modified Thrombolysis in Cerebral Infarction (mTICI) 2b/3: ~95%) and complication rates (hemorrhagic transformation, post-awakening stroke) were similar between the groups (all P>0.05). In regression analysis, smoking history, baseline National Institutes of Health Stroke Scale (NIHSS) score, and collateral circulation grade were independent predictors of outcome, while treatment modality was not. CONCLUSION: BT and D-MT demonstrate comparable efficacy and safety in treating anterior circulation LVO. The choice of strategy should consider patient-specific factors such as baseline neurological status and collateral circulation, rather than presumed superiority of either modality.