BRIDGING-THERAPY WITH INTRAVENOUS THROMBOLYSIS DOES NOT COMPROMISE FUNCTIONAL AND PROCEDURAL OUTCOMES IN PATIENTS WITH ACUTE STROKE BY LARGE VESSEL OCCLUSION (ID 944)

Presentation Topic

AS05 THROMBOLYSIS – EXCLUDING CLINICAL TRIAL RESULTS

Presenter

Rita Machado (Portugal)

Authors

Abstract

Abstract

Background And Aims

While prior intravenous thrombolysis (IVT) might complicate mechanical thrombectomy (MT) by favoring intracerebral hemorrhage (ICH) or limiting stent implantation management, it could improve outcome by dissolving distal thrombi not accessible by MT. We investigated functional outcomes of IVT in patients with stroke by LGO.

Methods

Historical cohort study including 663 consecutive patients admitted to a tertiary hospital with stroke by anterior LVO to perform MT, with or without prior IVT, over a four-year period. The influence of IVT on functional outcome (modified Rankin Scale (mRS)) and on mortality at month 3 was evaluated.

Results

Arterial recanalization during transportation (n=62, 9%) was significantly higher in patients who received IVT (rtPA+) (12.1% vs 4.8%, p=0.002). Of the 601 patients who underwent MT, 364 (61%) received prior IVT. The rate of successful recanalization (mTICI2b) was not superior in the rtPA+ group (adjusted OR 1.1, C.I. 95%: 0.7-1.9, p=0.625). The rate of ICH was similar between groups (adjusted OR 0.7, C.I. 95%: 0.5-1.1, p=0.174). mRS (OR 0.8, C.I. 95%: 0.6-1.1, p=0.128) and mortality (OR 0.7, C.I. 95%: 0.5-1.2, p=0.191) at month 3 were similar between groups. Moreover, two subgroup analyses performed on patients with (1) subtotal arterial recanalization (TICI 2a/2b) and (2) stent implantation, showed identical functional outcomes between groups, as reported above.

Conclusions

IVT favors arterial recanalization prior to MT, in patients transferred with stroke by LGO. When associated with MT, it does not seem to compromise functional and procedural outcomes.