Evidence map›Paper›PMID 41563403›Full record

ArticleNeuroradiology2026

A multicenter retrospective cohort study showing that bridging thrombolysis does not achieve better outcomes compared to direct mechanical thrombectomy in stroke due to internal carotid artery occlusion.

Isabel Siow, Keng Siang Lee, Benjamin Y Q Tan, Dominic W T Yap, Ching-Hui Sia, Anil Gopinathan, Cunli Yang, Pervinder Bhogal, Erika Lam, Oliver Spooner and 18 more

Abstract readMulticenter StudyComparative Study
PubMed Publisher
In one paragraph

Article in Neuroradiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors.

Isabel SiowMinistry of Health Holdings Singapore, Singapore, Singapore.
Keng Siang LeeNational Neuroscience Institute, Singapore, Singapore.
Benjamin Y Q TanNational University Health System, Singapore, Singapore.
Dominic W T YapMinistry of Health Holdings Singapore, Singapore, Singapore.
Ching-Hui SiaDepartment of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.
Anil GopinathanNational University Health System, Singapore, Singapore.
Cunli YangNational University Health System, Singapore, Singapore.
Pervinder BhogalThe Royal London Hospital, Barts NHS Trust, London, United Kingdom.
Erika LamThe Royal London Hospital, Barts NHS Trust, London, United Kingdom.
Oliver SpoonerThe Royal London Hospital, Barts NHS Trust, London, United Kingdom.
Lukas MeyerUniversity Medical Center Hamburg- Eppendorf, Hamburg, Germany.
Jens FiehlerUniversity Medical Center Hamburg- Eppendorf, Hamburg, Germany.
Panagiotis PapanagiotouHospital Bremen-Mitte, Bremen, Germany.
Andreas KastrupHospital Bremen-Mitte, Bremen, Germany.
Maria AlexandrouHospital Bremen-Mitte, Bremen, Germany.
Seraphine KutschkeUniversity Hospital Magdeburg, Magdeburg, Germany.
Qingyu WuUniversity Hospital Magdeburg, Magdeburg, Germany.
Anastasios MpotsarisUniversity Hospital Magdeburg, Magdeburg, Germany.
Volker MausUniversity Hospital Knappschaftskrankenhaus Bochum, Bochum, Germany.
Tommy AnderssonAZ Groeninge, Kortrijk, Belgium.
Vamsi GontuDepartment of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
Fabian ArnbergDepartment of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
Tsong Hai LeeLinkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Bernard P L ChanNational University Health System, Singapore, Singapore.
Raymond C S SeetNational University Health System, Singapore, Singapore.
Hock Luen TeohNational University Health System, Singapore, Singapore.
Vijay K SharmaNational University Health System, Singapore, Singapore.
Leonard L L YeoNational University Health System, Singapore, Singapore. leonardyeoll@gmail.com.

Funding

National Medical Research Council NMRC/MOH-TA19Nov-0003
6 · The paper itself

Abstract

background and purposeMechanical thrombectomy (MT) is an effective treatment for patients with acute ischaemic stroke secondary to internal carotid artery (ICA) occlusion. Intravenous thrombolysis (IVT) prior to MT is also commonly administered in suitable patients. This study aimed to compare the outcomes of patients with acute ICA stroke who were treated with direct MT versus combined IVT plus MT. Additionally, analysis was performed in different subgroups of patients such as those with large artery stenosis (LAA) to evaluate which subgroup of patients would benefit most from bridging IVT.

methodsThis multicenter retrospective cohort study included patients who were treated for acute ICA stroke from three comprehensive stroke centers between January 2015 and December 2019. Patients received direct MT or combined bridging IVT plus MT. Primary outcome was favorable functional outcome defined as modified Rankin Scale (mRS) 0-2 measured at 90 days after discharge. Secondary outcome measures included mRS on discharge, inpatient mortality and complications such as symptomatic intracranial hemorrhage (sICH), subarachnoid haemorrhage (SAH) and embolism of thrombus to new territories.

resultsAmong 352 patients, 178 (50.6%) patients underwent bridging IVT followed by MT and 174 (49.4%) underwent direct MT. The mean ± standard deviation age was 69.8 ± 14.6 years, 50.9% were male and median National Institutes of Health Stroke Scale was 16. At 90-days after discharge, patients who underwent bridging IVT had similar functional outcomes as those who underwent direct MT (OR = 1.53; 95% CI 0.68-3.42; p = 0.303). Bridging IVT was also not associated with improvement in discharge mRS score, decreased inpatient mortality, or difference in rate of complications compared to direct MT. In subgroup analyses, patients with underlying atherosclerosis treated with bridging IVT compared to direct MT had a higher rate of favorable functional outcome at 90 days (33.9% vs. 14.0%, p = 0.022).

conclusionsBridging IVT is not associated with better functional outcomes compared to direct MT in ICA stroke. However, in the subgroup of patients with underlying large-artery atherosclerosis stroke mechanism, bridging IVT appears to potentially confer beneficial outcomes. This should be validated in larger studies.

Indexed as

Carotid Artery, InternalCarotid StenosisStrokeThrombectomyThrombolytic TherapyAgedBridge TherapyFemaleHumansMaleRetrospective StudiesTreatment OutcomeBridgingBridging thrombolysisInternal carotid arteryIntravenous thrombolysisStrokeThrombectomy

Identifiers

PMID41563403

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.