ABSTRACT NUMBER: ESOC2026A1682 SAFETY AND EFFICACY OF BRIDGING THERAPY VERSUS INTRAVENOUS THROMBOLYSIS ALONE OR DIRECT ENDOVASCULAR THROMBECTOMY BEYOND 4.5 HOURS: A POST-HOC ANALYSIS OF THE CHABLIS-T TRIALS

Abstract Background and aims Whether bridging therapy provides additional clinical benefit over intravenous thrombolysis (IVT) alone or direct endovascular thrombectomy (EVT) in the extended time window remains uncertain. This study aimed to evaluate the association between treatment strategies and outcomes in patients with large vessel occlusion or severe stenosis presenting 4.5-24 hours after last known well. Methods Patients from CHABLIS-T and CHABLIS-T II (Chinese Acute Tissue-Based Imaging Selection for Lysis in Stroke-Tenecteplase)trials who received reperfusion therapy per protocol, including bridging therapy, IVT alone or direct EVT, were included in this post-hoc analysis. The primary outcome was the incidence of any intracranial hemorrhage (ICH) within 24-48 hours and secondary outcomes included functional outcomes assessed by the modified Rankin Scale (mRS) at 90 days. Multivariable logistic regression and inverse probability of treatment weighting (IPTW) based on propensity scores were applied to evaluate associations. Results A total of 284 patients were included (99 bridging therapy [34.9%], 127 IVT alone [44.7%], and 58 direct EVT [20.4%]). Compared with bridging therapy, both IVT alone (adjusted OR, 0.19, 95% CI, 0.09-0.38; P < 0.001) and direct EVT (adjusted OR, 0.42, 95% CI, 0.19-0.93; P = 0.03) were associated with a significantly lower risk of any ICH. After IPTW adjustment, IVT alone remained the association(adjusted OR 0.18, 95% CI 0.08-0.37; P < 0.001). Conclusions In this post-hoc analysis of the CHABLIS-T trials, bridging therapy was associated with a higher risk of any ICH compared with either IVT alone or direct EVT in stroke patients within 4.5-24 hours after last known well. Conflict of interest Xinru Wang: Nothing to disclosure