A new study has failed to show noninferiority of direct thrombectomy compared to bridging therapy with thrombolysis before thrombectomy for patients with large-vessel occlusion ischemic stroke. However, outcomes were very good for both groups.
The trial, SWIFT DIRECT, was presented on September 1 at the virtual European Stroke Organisation Conference (ESOC) 2021.
This is the fifth major trial to compare these two strategies. Results have conflicted as to whether direct thrombectomy is noninferior.
The SWIFT DIRECT investigators also presented a meta-analysis of all five trials. Results suggested that the direct approach was noninferior if less stringent noninferiority margins were used, but not with more stringent margins.
Asked how these results guide clinical practice, SWIFT DIRECT investigator Jan Gralla, MD, University Hospital Bern, Bern, Switzerland, replied: "The outcomes were very good in both arms, but the postintervention recanalization rate was much higher in the thrombolysis arm, so from my point of view, the results from this trial suggest that there is no reason to skip thrombolysis in patients with large-vessel occlusions."
Co-investigator Urs Fischer, MD, University Hospital Bern, agreed that even with the results of the meta-analysis, "there is no reason to drop tPA [tissue plasminogen activator] at present."
But he added: "There will probably be subgroups who will have the benefit of the direct thrombectomy approach, whereas others may benefit from the bridging strategy, so the aim in the future is an individualized approach."
