Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 26, 2021; 9(27): 8051-8060
Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8051
Bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion
Hong-Ju Ding, Cong Ma, Fu-Ping Ye, Ji-Fang Zhang
Hong-Ju Ding, Department of Emergency, Qingdao Jiaozhou Central Hospital, Qingdao 266300, Shandong Province, China
Cong Ma, Department of Neurology, Qingdao Jiaozhou Central Hospital, Qingdao 266300, Shandong Province, China
Fu-Ping Ye, Department of Gastrointestinal Surgery, Qingdao Jiaozhou Central Hospital, Qingdao 266300, Shandong Province, China
Ji-Fang Zhang, Department of Neurosurgery, Qingdao Municipal Hospital, School of Medicine, Qingdao University, Qingdao 266071, Shandong Province, China
Author contributions: Ding HJ, Ma C, Ye FP and Zhang JF designed the research study; Ding HJ and Zhang JF performed the research; Ma C contributed new reagents and analytic tools; Ye FP analyzed the data and wrote the manuscript; all authors have read and approve the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Qingdao Jiaozhou Central Hospital Institutional Review Board (Approval No. 20FD8731).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: No conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ji-Fang Zhang, MD, Chief Physician, Department of Neurosurgery, Qingdao Municipal Hospital, School of Medicine, Qingdao University, No. 1 Jiaozhou Road, Qingdao 266071, Shandong Province, China. zhangfang555@vip.163.com
Received: May 18, 2021
Peer-review started: May 18, 2021
First decision: June 15, 2021
Revised: June 29, 2021
Accepted: August 5, 2021
Article in press: August 5, 2021
Published online: September 26, 2021
Processing time: 121 Days and 5.4 Hours
Abstract
BACKGROUND

Intravenous thrombolysis is an important treatment for cerebral infarction. However, it is difficult to achieve good results if the patient is complicated with anterior circulation macrovascular occlusion. In addition, the vascular recanalization rate is low, so mechanical thrombectomy, that is, bridging therapy, is needed

AIM

To investigate the efficacy and safety of bridging therapy and direct mechanical thrombectomy in the treatment of cardiogenic cerebral infarction with anterior circulation macrovascular occlusion.

METHODS

Ninety-six patients in our hospital with cardiogenic cerebral infarction with anterior circulation macrovascular occlusion from January 2017 to July 2020 were divided into a direct thrombectomy group (n = 48) and a bridging group (n = 48). Direct mechanical thrombectomy was performed in the direct thrombectomy group, and bridging therapy was used in the bridging treatment group. Comparisons were performed for the treatment data of the two groups (from admission to imaging examination, from admission to arterial puncture, from arterial puncture to vascular recanalization, and from admission to vascular recanalization), vascular recanalization rate, National Institutes of Health Stroke Scale (NIHSS) and Glasgow Coma Scale (GCS) scores before and after treatment, prognosis and incidence of adverse events.

RESULTS

In the direct thrombectomy group, the time from admission to imaging examination was 24.32 ± 8.61 min, from admission to arterial puncture was 95.56 ± 37.55 min, from arterial puncture to vascular recanalization was 54.29 ± 21.38 min, and from admission to revascularization was 156.88 ± 45.51 min, and the corresponding times in the bridging treatment group were 25.38 ± 9.33 min, 100.45 ± 39.30 min, 58.14 ± 25.56 min, and 161.23 ± 51.15 min; there were no significant differences between groups (P=0.564, 0.535, 0.426, and 0.661, respectively). There was no significant difference in the recanalization rate between the direct thrombectomy group (79.17%) and the bridging group (75.00%) (P = 0.627). There were no significant differences between the direct thrombectomy group (16.69 ± 4.91 and 12.12 ± 2.07) and the bridging group (7.13 ± 1.23 and (14.40 ± 0.59) in preoperative NIHSS score and GCS score (P = 0.200 and 0.203, respectively). After the operation, the NIHSS scores in both groups were lower than those before the operation, and the GCS scores were higher than those before the operation. There was no significant difference in NIHSS and GCS scores between the direct thrombectomy group (6.91 ± 1.10 and 14.19 ± 0.65) and the bridging group (7.13 ± 1.23 and 14.40 ± 0.59) (P = 0.358 and 0.101, respectively). There was no significant difference in the proportion of patients who achieved a good prognosis between the direct thrombectomy group (52.08%) and the bridging group (50.008%) (P = 0.838). There was no significant difference in the incidence of adverse events between the direct thrombectomy group (6.25%) and the bridging group (8.33%) (P = 0.913).

CONCLUSION

Bridging therapy and direct mechanical thrombectomy can safely treat cardiogenic cerebral infarction with anterior circulation macrovascular occlusion, achieve good vascular recanalization effects and prognoses, and improve the neurological function of patients.

Keywords: Bridging therapy; Direct mechanical thrombectomy; Cardiogenic cerebral infarction; Anterior circulation macrovascular occlusion

Core Tip: Mechanical thrombectomy can be used directly to treat patients with cerebral infarction in order to avoid the problems of bridging therapy. We explored the efficacy and safety of bridging therapy and direct mechanical thrombectomy.