{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T08:14:12Z","timestamp":1783498452798,"version":"3.55.0"},"reference-count":23,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005743","name":"Universit\u00e0 Cattolica del Sacro Cuore","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005743","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The safety and efficacy of bridging therapy, which combines intravenous thrombolysis (IVT) with mechanical thrombectomy (MT), have not been fully explored in patients with basilar artery occlusion (BAO) and mild symptoms. This study aims to evaluate these factors in patients with BAO and an NIHSS score of less than 10.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter retrospective observational study involving consecutive BAO patients with NIHSS\u2009&lt;\u200910 from 10 European stroke centers between January 2017 and December 2024. We used inverse probability of treatment weighting (IPTW) to balance clinical variables. Primary safety outcomes included parenchymal hematoma (PH1\/PH2) and in-hospital death. Secondary efficacy outcomes included successful recanalization after MT and the 90-day functional\u00a0outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 134 patients were included. Bridging therapy did not increase the risk of PH (RR\u2009=\u20090.963; 95% CI 0.185\u20135.020;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.965) or in-hospital death (RR\u2009=\u20090.620; 95% CI 0.174\u20131.980;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.434). Additionally, IVT plus MT showed no significant improvement of the 90-day mRS score (ATE -0.187; 95%\u00a0CI -1.0690.694;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.675) or rates of 90-day mRS 0\u20132 (RR 1.192; 95% CI 0.483\u20133.011;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.704) and 03 (RR 1.997; 95% CI 0.738\u20135.867;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.186). No effect of IVT was observed on the rate of successful recanalization (RR 2.659; 95%\u00a0CI 0.663\u201313.518;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.190).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Bridging therapy appears to be safe for BAO patients with mild symptoms, but it does not provide additional benefits for functional outcomes or efficient recanalization rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-026-13883-1","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T09:35:08Z","timestamp":1781688908000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bridging therapy versus mechanical thrombectomy alone in patients with basilar artery occlusion and mild symptoms: a retrospective observational study"],"prefix":"10.1007","volume":"273","author":[{"given":"Simone","family":"Bellavia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea M.","family":"Alexandre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Scarcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Frisullo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Pedicelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Brunetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph D.","family":"Gabrieli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Da Ros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio A.","family":"Caragliano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orazio","family":"Buonomo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vittorio","family":"Semeraro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria P.","family":"Ganimede","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giancarlo","family":"Salsano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Mavilio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Chausson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghil","family":"Schwarz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Cascio Rizzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"Piano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Caproni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Abruzzese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilio","family":"Lozupone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Calabresi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8295-9271","authenticated-orcid":false,"given":"Aldobrando","family":"Broccolini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"13883_CR1","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1056\/NEJMoa2001123","volume":"382","author":"P Yang","year":"2020","unstructured":"Yang P, Zhang Y, Zhang L et al (2020) Endovascular thrombectomy with or without intravenous Alteplase in acute stroke. N Engl J Med 382:1981\u20131993","journal-title":"N Engl J Med"},{"key":"13883_CR2","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1001\/jama.2020.23523","volume":"325","author":"W Zi","year":"2021","unstructured":"Zi W, Qiu Z, Li F et al (2021) Effect of endovascular treatment alone vs intravenous Alteplase plus endovascular treatment on functional independence in patients with acute ischemic stroke: the DEVT randomized clinical trial. JAMA 325:234\u2013243","journal-title":"JAMA"},{"key":"13883_CR3","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1001\/jama.2020.23522","volume":"325","author":"K Suzuki","year":"2021","unstructured":"Suzuki K, Matsumaru Y, Takeuchi M et al (2021) Effect of mechanical thrombectomy without vs with intravenous thrombolysis on functional outcome among patients with acute ischemic stroke: the skip randomized clinical trial. JAMA 325:244\u2013253","journal-title":"JAMA"},{"key":"13883_CR4","doi-asserted-by":"publisher","first-page":"1833","DOI":"10.1056\/NEJMoa2107727","volume":"385","author":"NE LeCouffe","year":"2021","unstructured":"LeCouffe NE, Kappelhof M, Treurniet KM et al (2021) A randomized trial of intravenous alteplase before endovascular treatment for stroke. N Engl J Med 385:1833\u20131844","journal-title":"N Engl J Med"},{"key":"13883_CR5","doi-asserted-by":"publisher","first-page":"104","DOI":"10.1016\/S0140-6736(22)00537-2","volume":"400","author":"U Fischer","year":"2022","unstructured":"Fischer U, Kaesmacher J, Strbian D et al (2022) Thrombectomy alone versus intravenous alteplase plus thrombectomy in patients with stroke: an open-label, blinded-outcome, randomised non-inferiority trial. Lancet 400:104\u2013115","journal-title":"Lancet"},{"key":"13883_CR6","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/S0140-6736(22)00564-5","volume":"400","author":"PJ Mitchell","year":"2022","unstructured":"Mitchell PJ, Yan B, Churilov L et al (2022) Endovascular thrombectomy versus standard bridging thrombolytic with endovascular thrombectomy within 4.5 h of stroke onset: an open-label, blinded-endpoint, randomised non-inferiority trial. Lancet 400:116\u2013125","journal-title":"Lancet"},{"key":"13883_CR7","doi-asserted-by":"publisher","first-page":"81","DOI":"10.5853\/jos.2022.03755","volume":"25","author":"M Abdalkader","year":"2023","unstructured":"Abdalkader M, Finitsis S, Li C et al (2023) Endovascular versus medical management of acute basilar artery occlusion: a systematic review and meta-analysis of the randomized controlled trials. J Stroke 25:81\u201391","journal-title":"J Stroke"},{"key":"13883_CR8","doi-asserted-by":"publisher","first-page":"1910","DOI":"10.1056\/NEJMoa2030297","volume":"384","author":"LCM Langezaal","year":"2021","unstructured":"Langezaal LCM, van der Hoeven E, Mont\u2019Alverne FJA et al (2021) Endovascular therapy for stroke due to basilar-artery occlusion. N Engl J Med 384:1910\u20131920","journal-title":"N Engl J Med"},{"key":"13883_CR9","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1056\/NEJMoa2207576","volume":"387","author":"TG Jovin","year":"2022","unstructured":"Jovin TG, Li C, Wu L et al (2022) Trial of thrombectomy 6 to 24 hours after stroke due to basilar-artery occlusion. N Engl J Med 387:1373\u20131384","journal-title":"N Engl J Med"},{"key":"13883_CR10","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000210086","volume":"103","author":"E Nicolini","year":"2024","unstructured":"Nicolini E, Pracucci G, Ciacciarelli A et al (2024) Outcomes of mechanical thrombectomy in patients with acute basilar artery occlusion with mild to moderate symptoms. Neurology 103:e210086","journal-title":"Neurology"},{"key":"13883_CR11","doi-asserted-by":"publisher","first-page":"3187","DOI":"10.1161\/STROKEAHA.125.051485","volume":"56","author":"Y Xiao","year":"2025","unstructured":"Xiao Y, Zhang X, Yi T et al (2025) Effectiveness of endovascular treatment for acute mild basilar artery occlusion stroke: a multicenter real-world study. Stroke 56:3187\u20133198","journal-title":"Stroke"},{"key":"13883_CR12","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000214353","volume":"105","author":"CH Chen","year":"2025","unstructured":"Chen CH, Kim YS, Lee CW et al (2025) Bridging or direct thrombectomy in posterior circulation large-vessel occlusion stroke: analysis of binational registries and meta-analysis. Neurology 105:e214353","journal-title":"Neurology"},{"key":"13883_CR13","doi-asserted-by":"crossref","unstructured":"Zhubi E, Bissenov A, Engh MA, et al. 2025 Bridging therapy versus direct endovascular thrombectomy in basilar artery occlusion stroke: a systematic review and meta-analysis. Geroscience.","DOI":"10.1007\/s11357-025-01887-0"},{"key":"13883_CR14","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","volume":"61","author":"E von Elm","year":"2008","unstructured":"von Elm E, Altman DG, Egger M et al (2008) the strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344\u2013349","journal-title":"J Clin Epidemiol"},{"key":"13883_CR15","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1161\/01.STR.24.1.35","volume":"24","author":"HP Adams Jr.","year":"1993","unstructured":"Adams HP Jr., Bendixen BH, Kappelle LJ et al (1993) Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 24:35\u201341","journal-title":"Stroke"},{"key":"13883_CR16","doi-asserted-by":"publisher","first-page":"2981","DOI":"10.1161\/STROKEAHA.115.010049","volume":"46","author":"R von Kummer","year":"2015","unstructured":"von Kummer R, Broderick JP, Campbell BC et al (2015) The Heidelberg bleeding classification: classification of bleeding events after ischemic stroke and reperfusion therapy. Stroke 46:2981\u20132986","journal-title":"Stroke"},{"key":"13883_CR17","unstructured":"Schafer J. causaldrf: Estimating Causal Dose Response Functions. R package version 0.4.2. https:\/\/CRAN.R-project.org\/package=causaldrf. 2022."},{"key":"13883_CR18","unstructured":"Greifer N. cobalt: Covariate Balance Tables and Plots. R package version 4.6.1. https:\/\/CRAN.R-project.org\/package=cobalt. 2025."},{"key":"13883_CR19","doi-asserted-by":"publisher","first-page":"1869","DOI":"10.1007\/s00270-025-04251-z","volume":"48","author":"R Knapen","year":"2025","unstructured":"Knapen R, Doheim MF, Audebert HJ et al (2025) Intravenous thrombolysis prior to endovascular treatment in basilar artery occlusions: a patient pooled analysis of four randomized controlled trials. Cardiovasc Intervent Radiol 48:1869\u20131877","journal-title":"Cardiovasc Intervent Radiol"},{"key":"13883_CR20","doi-asserted-by":"publisher","first-page":"3039","DOI":"10.1007\/s00415-024-12353-w","volume":"271","author":"L Cai","year":"2024","unstructured":"Cai L, Wang L, Campbell BCV et al (2024) Endovascular thrombectomy with versus without intravenous thrombolysis in patients with acute basilar artery occlusion: a systematic review and meta-analysis. J Neurol 271:3039\u20133049","journal-title":"J Neurol"},{"key":"13883_CR21","doi-asserted-by":"publisher","first-page":"965","DOI":"10.1016\/S0140-6736(23)01142-X","volume":"402","author":"CB Majoie","year":"2023","unstructured":"Majoie CB, Cavalcante F, Gralla J et al (2023) Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials. Lancet 402:965\u2013974","journal-title":"Lancet"},{"key":"13883_CR22","doi-asserted-by":"publisher","first-page":"e1272","DOI":"10.1212\/WNL.0000000000011520","volume":"96","author":"F Alemseged","year":"2021","unstructured":"Alemseged F, Ng FC, Williams C et al (2021) Tenecteplase vs alteplase before endovascular therapy in basilar artery occlusion. Neurology 96:e1272\u2013e1277","journal-title":"Neurology"},{"key":"13883_CR23","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.036765","volume":"13","author":"Z Qiu","year":"2024","unstructured":"Qiu Z, Li F, Xie D et al (2024) Efficacy and safety of intravenous tenecteplase before endovascular thrombectomy for acute ischemic stroke: the multicenter, randomized, BRIDGE-TNK trial protocol. J Am Heart Assoc 13:e036765","journal-title":"J Am Heart Assoc"}],"container-title":["Journal of Neurology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13883-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00415-026-13883-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00415-026-13883-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T07:21:41Z","timestamp":1783495301000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00415-026-13883-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":23,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["13883"],"URL":"https:\/\/doi.org\/10.1007\/s00415-026-13883-1","relation":{},"ISSN":["0340-5354","1432-1459"],"issn-type":[{"value":"0340-5354","type":"print"},{"value":"1432-1459","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]},"assertion":[{"value":"10 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 April 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 May 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 June 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors have no competing interests to declare that are relevant to the content of this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}},{"value":"This study was conducted in accordance with the ethical standards of the responsible ethics committees and with applicable national and institutional guidelines. Ethical approval was obtained from the Ethics Committee of the Fondazione Policlinico Universitario A.Gemelli (protocol number 6410\/20, ID 3004), and conducted in accordance with the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}],"article-number":"403"}}