Bridging Study

IMS Study Investigators. Combined Intravenous and IntraArterial recanalization for acute ischemic stroke: the interventionsal management of stroke study. Stroke 2004; 35:904-911.

80 subjects received iv tpa .6 mg/kg, 60 mg maximum over 30 minutes within 3 hours, then additional via microcatheter compared to literature placebo and NINDS patients. 80 subjects had mean NIHSS 18, median onset to iv needle of 140 minutes. 3 month mortality 16 % numerically lower but n/s; sich was 6.3 %; 3 month outcome was better.

Notes recanalization of ICA's in studies is around 10 %. MCA's is around 25 %. In NINDS patients with NIHSS> 20, only 10 % had minor or no disability at 3 months v 2 % of placebo. OUtcomes looked at: MRS score 0-2 at 3 months; NIHSS score at 24 hours; rate of recanalization (TIMI 2 or 3) and a few others. 1477 patients were screened to produce 80 patients.

30 % of patients had mrs of 0-1 at 90 days, 28 % had NIHSS <1>95. 43 % had MRS <2> 10 was a slightly tougher group than NINDS. THERE WERE THREE VESSEL PERFS THOUGHT TO BE SECONDARY TO BLIND NAVIGATION IN MCA DUE TO CLOT PRESENT. All 3 were AICH. There were 4 recurrent strokes, 2 ICH. 4 patients underwent hemicraniectomy due to massive cerebral edema.

56 % of group that got ia tpa (62=n) 28 had maor occlusions or severe stenosis, 11 % total recanalization (TIMI 3) and 56 % partly recanalize. Of 34 patients who recanalized 34 % had a favorable outcome compared to 12 % who only got TIMI 0 or 1. Of those who got ia tpa in 3 hours, 43 % had MRS 0-1 v. 13 % who got it within 3-4 hours, 27 % who got it 4-6 hours.

Followup article Broderick Stroke 2007 evaluated 81 patients who had better results with bridging than with iv tpa alone, nonstatistically different hemorrhage rates with more results on way.