Abstract Number ‐ 272: Effect of the Time between Thrombolysis and Mechanical Thrombectomy on Outcomes of Stroke

Abstract

Introduction Administration of intravenous thrombolytics (IVT) within 4.5 hoursof symptoms onset, prior to performing mechanical thrombectomy(MT) in patients with acute ischemic stroke (AIS) secondary tolarge vessel occlusion (LVO) is thoroughly studied and hassuggested to improve reperfusion rates and clinical outcomes. [1,2] The outcomes of combined IVT and MT in STEMI patientshavebeen studied comprehensively and revealed worsening clinicaloutcomes when a shorter Lapse of Time (LoT) isintroduced.[3,4]Those studies stemmed the question of whetherLoTbetween IVT and MT in AIS patients has any significance. We investigated the effects of theLoTbetween IVT and MT onoutcomes of MT revascularization, as well as on the functionaloutcomes in patient with AIS with LVO. Methods We performed a retrospective analysis ofgathereddataduring a 6‐year period (2016‐2021) for all ourpatients with AIS and LVO who received both IVT and MT. We analyzed the MT revascularization outcomes using thethrombolysis in cerebral infarction(TICI)scale, as well as thestroke functional outcomes using the modified Rankin Scale(mRS)at discharge and 90 days to detectany significant differencesin positive or negative direction.LoT was measured as minutes from tPA administration and reperfusion on a continuous scale. Nonparametric tests (Kruskal‐Wallis analysis of variance on ranks, K‐W H) were used to determine if there were differences between mRS at discharge and at 90 days (as an ordinal variable, possible score 0–6) based on LoT. Results A total of 48 patients who received both IVT and MT were includedin the study.Those included were primarilyBlack (57.1%) and male(59.2%). Mean age was62.5 years (sd = 15.5, range 21–89 years).Median minutes between tPA and reperfusion was 74 minutes (min‐max = 44‐143 minutes). There were no significant differences betweenmRSatdischarge (K‐W H = 5.13, p = 0.40), nor at 90 days (K‐W H = 8.71, p = 0.19) as a function of theLoTbetween IVT and MT. There were no significant differences between TICI scores, as afunction of theLoTbetween IVT and MT, (K‐W H = 5.49,p = 0.14). Conclusions In this study we compared the impact of the time differencebetween IVT and MT on revascularization and functionaloutcome in patients with AIS and LVO.Unlike the findings in STEMI, we did not detect any significant outcomedifferences in MT results (TICI scale) and functional outcomes(mRSat discharge and 90 days), when IVT was given at differentLoTbeforeMT.