ABSTRACT NUMBER: ESOC2026A699 ROLE OF THROMBECTOMY TECHNIQUE IN BRIDGING INTRAVENOUS THROMBOLYSIS FOR BASILAR ARTERY OCCLUSION

Abstract Background and aims Endovascular treatment (EVT) is the standard of carefor acute basilar artery occlusion (BAO) although the role of bridging intravenous thrombolysis (IVT) prior to EVT remains debated. Whether the effect of bridging IVT differs across EVT techniques has not been systematically assessed. Methods We conducted a retrospective multicentre analysis including consecutive BAO patients treated with EVT at seven comprehensive stroke centres between 2019 and 2023. Patients were stratified according to first-line thrombectomy technique: direct thromboaspiration (BAOTHROMBOASPIRATION), stent retriever (BAOSTENT), or combined approach (BAOCOMBINED). Outcomes were analysed using inverse probability weighting to adjust for baseline imbalances. The primary endpoint was 90-day functional independence (mRS 0–3) and ordinal 90-day mRS shift. Secondary endpoints included 90-day excellent outcome, successful reperfusion, 90-day mortality, haemorrhagic transformation, and symptomatic intracerebral haemorrhage (sICH). Sensitivity analyses with trimmed weights and subgroup analyses were prespecified. Results A total of 517 patients were included: 200 BAOTHROMBOASPIRATION, 260 BAOSTENT and 57 BAOCOMBINED. In BAOTHROMBOASPIRATION patients, bridging IVT was associated with higher rates of favourable outcome (RR 1.47, 95% CI 1.00–2.16) and improved 90-day mRS shift. In BAOSTENT patients bridging IVT significantly reduced sICH risk (RR 0.27, 95% CI 0.09–0.77) while in BAOCOMBINED patients increased 90-day functional independence (RR 1.91, 95% CI 1.08–3.36). Results were consistent in sensitivity analyses. Conclusions The impact of bridging IVT in BAO varies across thrombectomy techniques but consistently trends toward benefit. These findings suggest that the role of bridging IVT should also be interpreted in light of the procedural context. Conflict of interest SB is a key opinion leader for RAPIDAI. TNN is Associate Editor of Stroke; advisory board for Brainomix, Aruna Bio; speaker for Genentech, Kaneka. RS is partially funded by the UCLH Biomedical Research Centre. All other authors have no conflicts of interests. Figure 1 - belongs to Results