ABSTRACT NUMBER: ESOC2026A2168 PROGRESSIVE LACUNAR STROKE AND THE EFFICACY AND SAFETY OF PROLONGED INTRAVENOUS THROMBOLYSIS

Abstract Background and aims Lacunar strokes are characterized by a high rate of progressive character and early recurrence. Therapeutic intervention is difficult, especially in the first hours after intravenous thrombolysis. Methods All consecutive patients who received intravenous thrombolysis (20 mg alteplase continuously for 10 hours) for progressive or early recurrence of ischemic stroke were included in the multicenter retrospective study. Patients with lacunar form were identified based on evidence from MRI or CT scans. Safety of treatment was assessed based on the occurrence of intracerebral hemorrhage and symptomatic intracerebral hemorrhage. Results 32 lacunar strokes were identified in 4 centers (45.5% men, 68.0±10.9 years). Neurological deficit corresponded to a median NIHSS of 5 points after a previous stroke, 11 points at the time of recurrence, and 7 points after rescue therapy. Improvement occurred in 59.4% of patients. A good clinical outcome (mRS 90day ≤2) was achieved by 59.4%. Mortality was 9.4%. We did not observe intracerebral hemorrhage. In contrast, in the group of non-lacunar strokes (33 patients, 51.5% men, 73.9±13.2 years, NIHSS 4 before deterioration), significant improvement occurred in 81.8% of cases. Neurological deficit corresponded to a median NIHSS of 10 at exacerbation and a median NIHSS of 4 at follow-up. 60.6% of patints achieved a good clinical outcome at 90day. The incidence of intracerebral hemorrhage was 18.2% (no symptomatic hemorrhage occurred) and mortality was 15.2%. Conclusions Therapy in the case of lacunar strokes was significantly less effective than in the case of non-lacunar strokes, but safer. Nevertheless, more than half of the patients benefited from the therapy. Conflict of interest Cernik David: nothing to disclose, Neradova Jarmila: nothing to disclose, Vondrackova Simona: nothing to disclose, Bilik Jan: nothing to disclose, Vachova Marta: nothing to disclose, Macko Jan: nothing to disclose, Neumann Jiri: nothing to disclose.