Abstract A043: Safety and Efficacy of Thrombolysis in Stroke Patients With Cerebral Cavernous Malformations

Introduction: Cerebral cavernous malformations (CCM) are rare vascular anomalies associated with increased risk of intracerebral hemorrhage (ICH). While intravenous thrombolysis (IVT) is a well-established treatment for acute ischemic stroke (AIS), its safety in patients with known or occult CCM remains uncertain due to the rarity of the condition, exclusion from early IVT trials, and frequent underdiagnosis. Methods: This retrospective cohort analysis of the 2016–2022 U.S. Nationwide Readmissions Database included adult patients hospitalized with moderate to severe AIS (National Institutes of Health Stroke Scale score of 6 or higher) and comorbid diagnosis of CCM. Patients were stratified based on receipt of IVT. The primary efficacy endpoint was functional independence at the time of discharge. Safety endpoints included the incidence of any ICH and in-hospital mortality. Results: Among 845 AIS patients with CCM, 240 (28.4%) received IVT (Figure 1) . IVT-treated patients had significantly higher rates of functional independence compared to those who did not receive IVT (46.4% vs. 24.6%, p < 0.001). There were no significant differences in rates of ICH (20.3% vs. 16.1%, p = 0.30) or in-hospital mortality (8.5% vs. 8.3%, p = 0.96). The observed risk differential of ICH associated with IVT was notably lower than reported in early IVT trials. Conclusions: This study represents the largest cohort to date evaluating IVT use in AIS patients with comorbid CCM. IVT was associated with improved functional outcomes without increased risk of ICH or in-hospital mortality. These findings support the selective use of IVT in AIS patients with known or highly suspected CCM, though prospective studies incorporating lesion-specific data are needed to optimize clinical decision-making.