ABSTRACT NUMBER: ESOC2026A1887 IMPACT OF INTRAVENOUS THROMBOLYSIS BEFORE THROMBECTOMY IN PATIENTS ACHIEVING COMPLETE RECANALISATION (TICI3)

Abstract Background and aims The benefit of intravenous thrombolysis (IVT) in acute ischemic stroke patients treated with mechanical thrombectomy (MT) achieving complete reperfusion (TICI 3) remains uncertain. Methods From our prospective registry of 784 cases of thrombectomy, we identified 290 patients with large-vessel occlusion (M1, dominant M2, distal ICA) treated with MT within the first 6 hours after stroke onset and achieving TICI3. Patients receiving (n=182) or not (n=108) IVT (alteplase) prior to MT were compared. Primary outcomes were 90-days modified Rankin Scale (mRS), symptomatic intracranial hemorrhage (sICH) and mortality at 90 days. Results Mean age was 71,08±13,69 years in IVT+MT versus 72,83±11,84 years in MT (p= 0,2506). NIHSS baseline median was 15,0[9,0] in IVT+MT versus 14,5[12,25] in MT (p= 0,4848). Onset-to-groin time was longer in MT alone (227,71±128,56 hours versus 276,73±216,56 hours, p = 0,03402) . Favorable outcome (mRS 0–2) occurred in 52.8% of IVT+MT versus 48.5% of MT (p=0.5116). Mortality at 90 days was 28.8% in IVT+MT versus 32.0% in MT (p=0.5997). Any ICH occurred in 27,65% of IVT+MT versus 19% of MT (p=0,0998). sICH occurred in 7.14% of IVT+MT versus 4.63% of MT (p=0.3793). Conclusions In patients treated with MT within the first 6 hours and achieving TICI3, IVT before MT didn’t lead to an excess of side effect but did not improve functional outcome, highlighting the need for further studies exploring the impact of intra-arterial thrombolysis at the end of MT. Conflict of interest B.Brilot, C. Ciobanu, D. Brisbois , O. Cornet, M. Aggour, F. Dister, E. Peters, P. Desfontaines: nothing to disclose