To bridge or not to bridge: summary of the new evidence in endovascular stroke treatment

Anna Podlasek (Lead / Corresponding author), Permesh Singh Dhillon, Waleed Butt, Iris Q. Grunwald, Timothy J. England

Research output: Contribution to journalEditorialpeer-review

7 Citations (Scopus)
53 Downloads (Pure)


Recently published summaries and meta-analyses of four randomised controlled trials (RCTs)1-5 comparing direct mechanical thrombectomy (dMT) and bridging therapy with intravenous (IV) thrombolytics (alteplase) suggested that dMT is non-inferior to bridging therapy to achieve good functional outcome 3 months after stroke (modified Rankin Score 0-2) with the non-inferiority margin (NIM) <-5%.5-7 However, there were considerable limitations in generalisability as three of the RCTs were performed in the Asian population, and the alteplase dose was different between studies (0.6 mg/kg or 0.9 mg/kg). Recently, preliminary results of two further RCTs (SWIFT-DIRECT8 and DIRECT-SAFE9) were presented at the 2021 World Stroke Congress and other conferences. Both RCTs (SWIFT-DIRECT and DIRECT-SAFE) compared dMT with bridging therapy, assuming a NIM of 12% and 10%, respectively. Both failed to confirm the non-inferiority of dMT approach, although it is worth noting that DIRECT-SAFE was terminated early in June 2021, with only 293 out of planned 780 participants recruited, following the publications of the other RCTs' results.9

Original languageEnglish
Article numbere001465
Pages (from-to)179-181
Number of pages3
JournalStroke and Vascular Neurology
Issue number3
Early online date1 Feb 2022
Publication statusPublished - 24 Jun 2022


  • cerebral infarction
  • clinical trial
  • stroke
  • thrombectomy
  • thrombolysis

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine


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