Abstract TP047: Cardiac Safety of Intravenous Thrombolysis Prior to Mechanical Thrombectomy in Acute Ischemic Stroke

Objective: The optimal reperfusion strategy for acute ischemic stroke (AIS), between bridging therapy versus direct mechanical thrombectomy (MT) remains debated, particularly with regards to cardiac safety. This study aimed to evaluate the impact of intravenous thrombolysis (IVT) prior to MT on early cardiac and neurological outcomes in AIS patients. Methods: We retrospectively analyzed AIS patients treated with MT between 2013 and 2021 at a comprehensive stroke center. Patients receiving bridging therapy were compared to those treated with direct MT. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) were applied to balance baseline characteristics. Logistic regression was utilized to assess associations between IVT and cardiac as well as neurological outcomes. Results: Among 784 patients (267 bridging therapy, 517 direct MT), the incidence of stroke-heart syndrome (SHS) within 2 weeks was similar between groups (27.0% vs. 24.2%, p=0.394). Multivariable analyses confirmed no significant effect of IVT on SHS in the original cohort (OR 1.061, 95% CI 0.713–1.571, p=0.769) or matching cohorts (PSM: OR 0.923, 95% CI 0.603–1.413, p=0.712; IPTW: OR 0.977, 95% CI 0.764–1.249, p=0.850). Subgroup analyses similarly showed no IVT effect across age, etiology, cardiac history, lesion characteristics, or onset-to-puncture time. IVT also was not significantly associated with hemorrhagic transformation (OR 1.343, 95% CI 0.943–1.914, p=0.102), symptomatic intracranial hemorrhage (OR 1.077, 95% CI 0.640–1.815, p=0.779), or unfavorable functional outcomes at discharge (OR 1.551, 95% CI 0.998–2.410, p=0.051) and 90 days (OR 1.404, 95% CI 0.939–2.097, p=0.098). Conclusions: IVT prior to MT was not associated with increased risk of early cardiac events or poor neurological outcomes. These results support the cardiac and neurological safety of bridging therapy in AIS patients and provide novel evidence directly addressing SHS in the context of reperfusion strategies.