ABSTRACT NUMBER: ESOC2026A1415 INTRAVENOUS THROMBOLYSIS PLUS ENDOVASCULAR TREATMENT VERSUS ENDOVASCULAR TREATMENT ALONE IN ACUTE ISCHAEMIC STROKE PATIENTS PRESENTING AT PRIMARY STROKE CENTERS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract Background and aims Intravenous thrombolysis (IVT) is routinely administered, when not contra-indicated, in patients with acute ischaemic stroke (AIS) and large-vessel occlusion (LVO) who present at primary stroke centers [PSCs; centers without capability for endovascular treatment (EVT)] and are subsequently transferred for EVT. However, it is unknown whether IVT plus EVT (bridging therapy) is beneficial compared to EVT-alone in this setting. This study aims to evaluate the efficacy and safety of bridging therapy compared to EVT-alone in patients with LVO-AIS presenting at PSCs. Methods We performed a systematic literature search of MEDLINE, SCOPUS, and conference proceedings through January 3, 2026. Eligible studies included randomised or observational cohort studies enrolling patients with LVO-AIS presenting at PSCs, comparing bridging therapy with EVT-alone. Meta-analysis was performed using the random-effects model and calculating pooled odds ratios (ORs). Results Thirteen observational studies were included, comprising a total of 2,665 patients treated with bridging therapy versus 3,156 patients treated with EVT alone. Bridging therapy was associated with increased odds of good functional outcome (mRS 0-2; OR: 1.60; 95%CI: 1.31-1.95; p<0.01), excellent functional outcome (mRS 0-1; OR: 1.83; 95%CI: 1.49-2.24; p<0.01), and reduced disability at 90 days (≥1-point mRS improvement; common OR: 1.70; 95%CI: 1.23-2.36; p<0.01). Symptomatic intracranial haemorrhage was similar between the two groups (OR: 0.92; 95%CI: 0.71-1.19; p=0.52), while 90-day mortality was significantly lower in the bridging therapy (OR: 0.65; 95%CI: 0.52-0.82; p<0.01). Conclusions Pooled evidence from observational studies supports bridging therapy over BMT alone in patients with LVO-AIS presenting at PSCs. Conflict of interest Nothing to disclose.