ABSTRACT NUMBER: ESOC2026A2022 ASSOCIATION OF ULTRAFAST THROMBOLYSIS WITH EARLY NEUROLOGICAL OUTCOME IN ACUTE ISCHEMIC STROKE

Abstract Background and aims Intravenous thrombolysis (IVT) is a highly time-sensitive and effective acute ischemic stroke (AIS) treatment. To minimize door-to-needle-times (DNT), we implemented an optimized stroke pathway based on the Helsinki Stroke model, including EMS pre-notification, AI-assisted real-time CT analysis, and bolus administration before CT angiography. This study aimed to characterize patient-related aspects associated with different DNT intervals. Ultrafast thrombolysis was defined as DNT ≤20 min. Methods We retrospectively analyzed IVT-treated AIS patients treated 2021-2024 excluding those undergoing additional thrombectomy. Patients were stratified by DNT; groups were compared regarding demographics, admission characteristics, and in-hospital outcomes. Results Among 669 patients, DNT was ≤20 min in 30.8%, 21-30 min in 44.9%, 31-60 min in 14.8%, and >60 min in 9.6%. In the ultrafast group, mean DNT was 15.7 min (SD 3.49). Baseline NIHSS differed significantly across groups, with patients in the ultrafast group presenting with slightly higher NIHSS scores (medians [IQR]: 5 [3-8], 5 [2-8], 5 [2-7], 4 [1-7]; p=0.026). Discharge mRS (1-5) varied across groups, with the fastest-treated group showing the most favorable functional status (medians [IQR]: 3 [0-4], 2 [1-4], 3 [1-4), 3 [1-4.75]; p=0.030). Early neurological improvement, measured by median NIHSS change, declined stepwise with longer DNT (median delta NIHSS [IQR]: 3 [1-5], 2 [1-4.75], 1 [0-3], 1 [0-4]; p<0.001). Conclusions Patients receiving ultrafast thrombolysis under 20 minutes presented with slightly more severe strokes but achieved greater early neurological improvement. These results highlight the clinical benefit of systematic process optimization in acute stroke care. Conflict of interest All authors: nothing to disclose. Figure 1 - belongs to Conclusions