Abstract WP202: Thrombectomy versus Combined Thrombolysis and Thrombectomy for Primary Medium and Distal Intracranial Occlusions: A Propensity-Score Matched Multicenter Analysis

Abstract

Background: Mechanical thrombectomy (MT) has demonstrated superiority over medical therapy for acute ischemic stroke (AIS) with large vessel occlusion (LVO). The role of adjunctive intravenous thrombolysis, such as intravenous tissue plasminogen activator (IVtPA), with MT remains unclear, especially for medium vessel occlusion (MeVO). This multicenter study aimed to compare outcomes between MT alone and MT+IVtPA in patients with MeVO. Methods: Data from 827 patients treated at 37 academic centers in North America, Asia, and Europe were collected between September 2017 and July 2021. Propensity score matching was performed to create two well-balanced groups: MT alone and MT+IVtPA. Baseline characteristics, procedural details, and clinical outcomes were analyzed. Results: After propensity score matching, 577 patients (315 in the MT alone group and 262 in the MT+IVtPA group) were included in the analysis. The two groups had comparable baseline characteristics, except for longer onset-to-puncture and onset-to-recanalization times in the MT alone group. In univariable regression, all outcomes were comparable between the two groups, except for higher mRS 0-2 rates in the MT+IVtPA group. Multivariable regression analysis showed no significant differences in first pass effect (FPE), number of passes, Thrombolysis in Cerebral Infarction (TICI) scores, rates of mRS 0-1, mRS 0-2, mortality, or intracranial hemorrhage between the groups. Conclusion: In patients with primary medium and distal intracranial occlusions, MT alone and MT+IVtPA yielded similar clinical outcomes. These findings suggest that adding IVtPA to MT may not confer additional benefit in this population. Further research is needed to determine the optimal treatment approach for MeVO.