Abstract 41: Endovascular Treatment Alone versus Endovascular Treatment With Intravenous Thrombolysis in Patients With Tandem Occlusion: Analysis of the TITAN and ETIS Registries

Abstract

Introduction: The benefit of intravenous thrombolysis (IVT) prior to endovascular treatment (EVT) in patients with acute ischemic stroke due to anterior circulation tandem occlusion is not well established. In this study, we aimed to investigate the effect of IVT on the outcome of EVT for anterior circulation tandem occlusions Methods: Individual data were pulled from the prospective TITAN and ETIS registries. Patients with anterior circulation tandem occlusion treated with EVT with and without cervical internal carotid artery ( c-ICA) stenting were included. Patents were divided into two groups (IVT+/IVT-) based on IVT treatment. Inverse Probability Treatment Weighting (IPTW) analysis were used to compare the outcomes between the two groups. Results: A total of 602 patients were included of whom 380 (62%) patients received IVT prior to EVT (IVT+). Mean age was 64 and 62 years in IVT+ and IVT - groups, respectively. Median NIHSS was 16 in both groups. Onset to imaging time was shorter in IVT+ group (median 103 vs. 140 minutes). In contrast, imaging to puncture time was longer in IVT+ group (median, 107 vs. 91 minutes). In IPTW analysis, IVT was associated with higher odds of favorable outcome (90-day modified Rankin Scale [mRS] 0-2), excellent outcome (mRS 0-1) and successful reperfusion (modified Treatment in Cerebral Ischemia [mTICI] 2b-3). IVT was also associated with lower odds of any intracranial hemorrhage but not with symptomatic hemorrhage or parenchymal hemorrhage. In secondary analysis of patients treated with cervical internal carotid artery stenting, IVT was associated with higher odds of favorable outcome, and lower odds of mortality. Conclusion: Up to our knowledge, this is the first study comparing EVT alone to EVT+IVT in anterior circulation tandem occlusion patients. IVT prior to EVT was associated with better functional outcome and higher odds of successful reperfusion.