Abstract TMP5: Intravenous Thrombolysis Influence After Successful Mechanical Thrombectomy For Large Vessel Occlusion; Not To Skip Tpa Yet!

Background: Despite the high rates of successful reperfusion in the randomized mechanical thrombectomy (MT) trials, only 27% of large vessel occlusion (LVO) patients treated successfully with MT achieved functional independence at 90 days. One proposed theory is impaired distal reperfusion with persistent small thrombi within the microcirculation despite complete recanalization “the no-Reflow phenomenon”. These distal small thrombi would be more suitable to dissolve by thrombolytics.

Methods: This is a retrospective cohort obtained from Get with the guidelines stroke (GWGS) database available at Medical University of South Carolina Comprehensive Stroke Center (CSC) for LVO patients presented within 4.5 hours of last known well (LNW) between January/2018- June/2022. We aim to investigate the influence of intravenous thrombolysis (IVTPA) on the functional independence mRS (0-2) after a successful MT defined as modified thrombolysis score (mTICI2c-3).

Results: Of 188 LVO patients who achieved successful reperfusion (TICI2c-3) during the study period, 93 (49%) arrived at our CSC within 4.5 hours of LSW, of them 40 patients (43%) received IVTPA. There was no difference in age, gender, race and initial NIHSS between patients who received IVTPA and those who did not receive IVTPA. Patients received IVTPA arrived at the CSC earlier [median LNW 60 min IQR (51 - 151) vs 165 min (IQR 103- 214), p = <0.001), and had higher ASPECTS score [median 9, IQR (8-10) vs 7, IQR (7-10) p= 0.027]. There was no difference in the collaterals score, clot burden score, site of LVO, tandem nature, door to reperfusion times, post-procedural intracranial hemorrhage or stroke etiology between the two groups. Discharge functional independence mRS (0-2) was achieved more in IVTPA group 65% vs 42% p= 0.025. After adjusting for ASPECTS score, IVTPA patients had higher odds of achieving mRS (0-2) at discharge compared to patients who did not receive IVTPA within 4.5 hours of LNW [aOR 2.42, 95%CI (1.02- 5.75), p= 0.046].

Conclusion: Intravenous thrombolysis can still influence LVO stroke patients' outcomes with complete revascularization. This positive effect might be related to distal microthrombi thrombolysis and subsequent improvement of the microcirculation flow beyond the occlusion site