Bridging Therapy and Occlusion Site Influence Symptomatic Hemorrhage Rate after Thrombectomy: A Daily Practice Study in 623 Stroke Patients

<b><i>Background:</i></b> Comparison of symptomatic intracranial hemorrhage (SICH) rates between stroke patients treated with bridging therapy (BT) and primary mechanical thrombectomy (PMT) are scarce and difficult to interpret due to baseline differences between both populations. <b><i>Methods:</i></b> Retrospective analysis of patients with acute ischemic stroke treated with endovascular therapy (BT or PMT) was performed at our center between January 2010 and June 2017. <b><i>Results:</i></b> Six hundred twenty-three patients were included. Global SICH rate was 9% overall: 6.8% in the PMT group and 12.6% in the BT group. The following factors significantly associated with SICH after multivariate analysis: MCA occlusion (<i>p</i>: 0.047), stroke of unknown origin (<i>p</i>: 0.025), BT (<i>p</i>: 0.024), and procedural time over 65 min (<i>p</i>: 0.027). The following variables presented a statistically significant higher frequency in patients treated with PMT: atrial fibrillation (<i>p</i>: 0.005), anticoagulant medication (<i>p</i> &#x3c; 0.001), wake-up strokes (<i>p</i> &#x3c; 0.001), atherothrombotic etiology (<i>p</i> &#x3c; 0.05), combined thrombectomy technique (<i>p</i>: 0.008), longer procedural times (<i>p</i>: 0.025), and favorable outcome at 3 months (<i>p</i>: 0.011). The following variables presented a statistically significant higher frequency in patients treated with BT: antiplatelet medication (<i>p</i>: 0.048), MCA occlusions (<i>p</i>: 0.017), cardioembolic etiology (<i>p</i> &#x3c; 0.05), stent retriever/aspiration technique (<i>p</i>: 0.008), and SICH (<i>p</i>: 0.013). Patients with MCA occlusions had twice the risk of SICH after BT than after PMT (16.4 and 8.6%, <i>p</i>: 0.038). <b><i>Conclusions:</i></b> In this clinical series, the SICH rate was higher in patients treated with BT than in those treated with PMT. Relevant differences in baseline (related to IVT contraindications) were found between both groups. Randomized studies of BT versus PMT in populations with similar baseline characteristics might be of interest.