Abstract P5: IV Alteplase Benefits Thrombectomy Patients With Incomplete TICI 2 Endovascular Reperfusion but Not Those With Complete TICI 3 Endovascular Reperfusion

Abstract

Introduction: There is debate regarding how IV tPA influences the efficacy of Endovascular therapy (EVT). One hypothesized potential benefit of thrombolytics is in patients with incomplete endovascular reperfusion. We compared discharge disposition in EVT patients with TICI 2 or TICI 3 reperfusion who received IV tPA with those who did not. Methods: Data from the Providence System Stroke Registry for acute ischemic stroke patients receiving EVT between January 2015 and May 2020 with a TICI 2 or TICI 3 reperfusion grade were used. Patients presenting later than the conventional 4.5 hour IV tPA window were excluded. Multinomial regressions were used to assess if EVT patients with a TICI 2 or TICI 3 who received IV tPA compared to those who did not receive IV tPA had greater odds of being discharged as expired or hospice or other location (acute care or long term care, skilled nursing facility, left against medical advice), compared to home or inpatient rehabilitation (IRF), adjusting for patient age, sex, race and ethnicity, last known well to arrival, NIHSS at admit, and medical history. Adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) are reported. Results: Of 419 EVT patients with TICI 2, 50.1% (n=210) received IV tPA and 49.9% (n=209) did not. Of 771 EVT patients with TICI 3, 48.4% (n=373) received IV tPA and 51.6% (n=398) did not. EVT patients with TICI 2 who were not treated with IV tPA were 59% less likely to be discharged as expired or hospice than home or IRF than those treated with IV tPA (AOR=0.414, 95% CI: 0.203, 0.844), and 63% less likely to be discharged somewhere other than home/IRF (AOR=0.372, 95% CI: 0.217, 0.636) than home/IRF. Among EVT patients with TICI 3, multivariate analyses indicated there was no greater likelihood of being discharged expired or to hospice than home/IRF (AOR=0.682, 95%CI: 0.434, 1.07) or discharged somewhere other than home/IRF (AOR=0.839, 95%CI: 0.592, 1.19) between those who received IV tPA and those who did not. Conclusions: Thrombectomy patients with TICI 2 reperfusion had better discharge outcome if they were treated with IV tPA. However, in completely reperfused patients with TICI 3 reperfusion outcome was not affected by prior IV tPA administration.