Abstract 40: Endovascular Treatment With Or Without Intravenous Alteplase For Acute Ischemic Stroke Due To Basilar Artery Occlusion

Abstract

Background and Purpose: It remains controversial if endovascular treatment (EVT) can improve the outcome of patients with acute basilar artery occlusion (BAO). This study aims to compare the functional outcomes between EVT with and without intravenous thrombolysis (IVT) first in patients with acute ischemic stroke (AIS) caused by BAO. Methods: AIS patients with BAO who underwent EVT within 24 hours of onset were enrolled in this multicenter cohort study, and the efficacy and safety were compared between the IVT+EVT and direct EVT. The primary outcome was the 90-day functional independence (modified Rankin Scale of 0-2). All outcomes were assessed with adjusted odds ratio (aOR) from the multivariable logistic regression. In addition, a meta-analysis was performed on all recently published pivotal studies and incorporating these studies on functional independence after EVT in BAO patients. Results: Of 310 BAO patients enrolled, 241 (78%) were treated with direct EVT and 69 (22%) with IVT+EVT. Direct EVT was associated with a worse functional outcome (aOR, 0.46 [95% CI, 0.25-0.87]; P =0.02). IVT+EVT was associated with a lower percentage of patients who needed ≥ 3 passes of the stent retriever (10.14% vs 20.75%). The meta-analysis regression revealed a potential positive correlation between bridging with IVT first and functional independence (r, 0.14 [95% CI: 0.05-0.24]; P<0.01). Conclusions: This study showed that compared to direct EVT, EVT with standard IVT first was associated with better functional outcomes in BAO patients treated within 24 hours of onset. The meta-analysis demonstrated the similar favorable efficacy of IVT first followed by EVT in BAO patients.