ABSTRACT NUMBER: ESOC2026A1368 ONGOING INTRAVENOUS THROMBOLYSIS DURING MECHANICAL THROMBECTOMY AND SUCCESSFUL REPERFUSION IN ACUTE ISCHEMIC STROKE

Abstract Background and aims Randomised trials have not shown a clear benefit on function outcome of bridging IV thrombolysis (IVT) over direct endovascular thrombectomy (EVT). However meta-analyses and observational data suggest better technical success with bridging, particularly when IVT is ongoing during EVT. We aimed to evaluated whether IVT still infusing at groin-puncture and shorter IVT-to-groin-puncture times are associated with better angiographic reperfusion after EVT. Methods We analysed consecutive EVT-treated patients from the ASTRAL registry (Lausanne, Switzerland). IVT was considered as ongoing during EVT if groin-puncture occurred ≤65 minutes from IVT start. The primary outcome was successful angiographical reperfusion (TICI-score≥2b). Analyses were adjusted for age, sex, vascular risk factors, baseline NIHSS and ASPECTS, onset-to-puncture time, occlusion site, and care organisation (“drip-and-ship” vs “mothership”). Results Of 1732 consecutive patients (mean/SD age 70.8/14.6, 45% female) undergoing EVT, 714 (41.2%) were EVT-only, 623 (36.0%) had IVT completed before groin puncture, and 395 (22.8%) had ongoing IVT at EVT start. eTICI≥2b was achieved in 1562 (90.2%) patients. Ongoing IVT at puncture was associated with higher odds of TICI≥2b (aOR=2.12, 95%CI=1.34–3.38), with no increased risk of haemorrhage (aOR=0.97, 95%CI=0.73-1.28). In bridging patients, longer IVT-to-EVT intervals were associated with lower odds of TICI≥2b (per additional hour: aOR=0.58,95%CI 0.44–0.76). Conclusions IVT still ongoing at groin puncture and shorter IVT-to-puncture intervals were associated with more near-complete angiographic reperfusion. These findings complement prior work showing time-dependent effects of thrombolysis-to-puncture interval on reperfusion and functional outcome, and provide mechanistic support for adjunct thrombolysis after suboptimal EVT reperfusion. Conflict of interest Davide Strambo: advisory board for Boehringer Ingelheim