ABSTRACT NUMBER: ESOC2026A1709 INTRAVENOUS THROMBOLYSIS BEFORE THROMBECTOMY IN STROKE: A META-ANALYSIS OF RANDOMIZED TRIALS

Abstract Background and aims Whether intravenous thrombolysis (IVT) should be administered prior to mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) remains uncertain. Trials have failed to demonstrate noninferiority of MT alone compared with bridging therapy using intravenous alteplase, while recent evidence suggests potential benefit with Tenecteplase. This meta-analysis aimed to evaluate the efficacy and safety of IVT prior to MT. Methods We systematically identified randomized controlled trials evaluating the effect of IVT prior to MT compared to MT alone for stroke with LVO. The primary efficacy outcome was functional independence, defined as a modified Rankin Scale (mRS) score of 0–2 at 90 days. The primary safety outcome was symptomatic intracranial hemorrhaege (sICH). Results Seven phase III randomized controlled trials involving 2,884 patients were included. In the pooled analysis, intravenous thrombolysis prior to thrombectomy was associated with numerically higher, but not statistically significant, likelihood of functional independence at 90 days compared with MT alone (mRS 0–2; odds ratio [OR] 1.13; 95% confidence interval [CI], 0.96–1.34). IVT prior to MT was not associated with an increased risk of sICH compared with MT alone (OR, 1.20; 95% CI, 0.86–1.68). Conclusions Among patients with AIS due to LVO, IVT prior to MT did not result in a statistically significant improvement in functional independence. However, the observed trend toward benefit underscores the need for further high-quality studies to clarify whether specific thrombolytic agents confer a clinically meaningful benefit when administered prior to MT. Conflict of interest Bowei Zhang, Aoming Jin, and Yongjun Wang have nothing to disclose Figure 1 - belongs to Conclusions