Background and objective Intravenous tissue plasminogen activator administration (IV-tPA) is the only standard treatment for acute ischemic stroke patients, but its therapeutic effect on in large artery intracranial occlusive disease (LAICOD) is questionable. We attempted to analyze the recanalization rate of IV-tPA in LAICOD patients and clinical results of additional intra-arterial thrombolysis (IA-Tx) on non-recanalized patients after IV-tPA.

Methods We included 212 patients who treated IV-tPA and/or IA-Tx. CT-angiography (CTA) was taken as an initial imaging study and acute stroke MRI was performed immediately after IV-tPA administration. We analyzed the recanalization rate, favorable clinical outcomes (mRS: 0-2) and the hemorrhagic complication rate based on additional IA-Tx and perfusion/diffusion (P/D)-mismatching.

Results Thirty-four patients were recanalized after IV-tPA but 178 patients were not. 118 patients were treated with IV-tPA only and 60 patients were treated with additional IA-Tx. The overall recanalization rate of LAICOD after IV-tPA was 16.0%, among these recanalized patients 82.4% had favorable outcomes. The recanalization rate after additional IA-Tx was 80.0%, and favorable outcome was significant better than who treated IV-tPA only (p=0.049). In patients who treated additional IA-Tx, P/D-mismatched patients led to fewer hemorrhagic complications (p=0.046) and better clinical outcomes (p=0.000) than P/D-matched patients.

Conclusion The recanalization rate after IV-tPA in LAICOD patients was low. Additional IA-Tx for non-recanalized patients after IV-tPA could improve the patient outcomes. And P/D-mismatch on acute stroke MR, which taken before the IA-Tx. was good indicator for the safety and effectiveness for additional IA-Tx.

Disclosures Y. Won: None. D. Yoo: None.