Functional and radiological outcomes after bridging therapy versus direct thrombectomy in stroke patients with unknown onset: Bridging therapy versus direct thrombectomy in unknown onset stroke patients with 10-point ASPECTS

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.