Abstract WMP90: Is Endovascular Thrombectomy More Effective Than IV-tPA For Distal Vessel Occlusions? Propensity Score-matched Analysis From K-net Registry

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Background and Purpose: The benefit of endovascular thrombectomy (EVT) for acute ischemic stroke due to primary distal vessel occlusions is unclear. We assessed whether outcome of acute ischemic stroke patients treated with EVT for primary distal vessel occlusions was better than intravenous tissue-type plasminogen activator (IV-tPA) alone. Materials and Methods: We investigated data from K-NET Registry, which is a prospective, multicenter, observational registry of acute ischemic stroke patients treated with EVT or IV t-PA in Kanagawa, Japan. We evaluated the patients who had primally distal vessel occlusion and were treated with EVT (with or without IV-tPA) or IV tPA alone. Distal vessel occlusion was defined as middle cerebral artery M2-M3, anterior cerebral artery or posterior cerebral artery occlusion. Propensity score-matched analysis was conducted to compare outcomes between EVT and IV-tPA alone. Primary outcome was good outcome at 90 days, defined as mRS of 0 to 2 or not worsening compared to pre-stroke mRS. Safety outcome was the occurrence of all hemorrhage and symptomatic hemorrhage. Results: 703 patients with distal vessel occlusion (MCA M2, 436 cases, M3, 167 cases, ACA 48 cases, PCA 52 cases) were included in this study. 461 cases were treated with EVT and 242 were IV-tPA alone. Propensity-score matching paired 110 patients with EVT and 110 patients with IV-tPA. There were no significant differences in good clinical outcome (EVT 65.4%, IV-tAP 60.0%), all hemorrhage (EVT 15.4%, IV-tAP 11.8%) and symptomatic hemorrhage (EVT 4.5%, IV-tAP 1.8%). Dividing EVT group into EVT with IV-tPA and EVT alone, there were no significant differences in outcomes compared to IV-tPA alone. Conclusions: The benefit of EVT for acute primary distal vessel occlusions was similar as IV-tPA alone. Although IV-tPA is a first line treatment for primary distal vessel occlusions, EVT is a feasible treatment for patients who have contraindication to IV-tPA.