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SNIS 21st annual meeting electronic poster abstracts
E-100 Intravenous thrombolysis in distal medium middle cerebral artery occlusion patients with unsuccessful mechanical reperfusion
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  1. S Ghozy1,
  2. A Dmytriw2,3,
  3. N Cancelliere3,
  4. V Pereira4,
  5. H Salim2,5,
  6. B Musmar6,
  7. R Kadirvel1,7,
  8. A Guenego8
  1. 1Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
  2. 2Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
  3. 3Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, University of Toronto, Toronto, ON, Canada
  4. 4Neurovascular Centre, Divisions of Therapeutic Neuroradiology and Neurosurgery, St. Michael Hospital, Mayo Clinic, Toronto, ON, CANADA
  5. 5Department of Radiology, Johns Hopkins Hospital, Baltimore, MD
  6. 6Department of Neurologic Surgery, Mayo Clinic, Baton Rouge, LA
  7. 7Department of Radiology, Mayo Clinic, Rochester, MN
  8. 8Department of Diagnostic and Interventional Neuroradiology, Erasme University Hospital Bruxelles, Belgium

Abstract

Background The efficacy and safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients undergoing mechanical thrombectomy (MT) for distal, medium vessel occlusions (DMVO) is not well established. This study investigates whether IVT impacts outcomes in DMVO patients, particularly in those with unsuccessful or partial recanalization after MT.

Methods We conducted a retrospective, multicenter study using data from the Multicenter Analysis of primary Distal medium vessel occlusions: effect of Mechanical Thrombectomy (MAD-MT) registry. The study population included acute ischemic stroke patients with DMVO in the M2, M3, and M4 segments of the MCA, treated with or without IVT followed by MT and a final modified Thrombolysis in Cerebral Infarction (mTICI) score of 0, 1, or 2a. The primary outcome was functional independence, assessed by the 90-day modified Rankin Scale (mRS) of 0–1 or 0–2.

Results The study comprised 210 patients with final mTICI 0 to 2a, with 130 undergoing MT alone and 80 receiving IVT followed by MT (figure 1). Logistic regression analysis revealed no significant difference in clinical outcomes between groups, with odds ratios (ORs) for achieving a 90-day mRS of 0–1 and 0–2 being 1.13 (95% CI 0.52 to 2.45; p=0.75) and 1.09 (95% CI 0.57 to 2.07; p=0.79), respectively. The odds of symptomatic intracerebral hemorrhage (sICH) were similar between groups (OR 0.68, 95% CI 0.30 to 1.54; p=0.37), as were the odds of intracranial hemorrhage (ICH) of any type (OR 1.50, 95% CI 0.89 to 2.52; p=0.22) (figure 2).

Conclusions In AIS patients with DMVO and unsuccessful or partial recanalization after MT, IVT did not significantly improve clinical outcomes. Additionally, IVT did not increase the risk of hemorrhagic complications. These findings suggest that while IVT is safe in this context, its may not improve outcomes for patients with unsuccessful MT.

Abstract E-100 Figure 1
Abstract E-100 Figure 1
Abstract E-100 Figure 2
Abstract E-100 Figure 2

Disclosures S. Ghozy: None. A. Dmytriw: None. N. Cancelliere: None. V. Pereira: None. H. Salim: None. B. Musmar: None. R. Kadirvel: None. A. Guenego: None.

https://doi.org/10.1136/jnis-2024-SNIS.205

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