Oral Presentation Australian and New Zealand Stroke Organisation Conference 2026

Pre-thrombectomy reperfusion rates following thrombolysis up to 24 hours after symptom onset (139796)

Chris Kwan 1 , Bill O'Brien 2 , Carlos Garcia‐Esperon 3 , Christopher Blair 4 , Emma Harrison 5 , James Evans 2 , Leon Edwards 1 , Timothy Ang 4 , Martin Jude 6 , Christine Cannon 6 , Cheryl Carcel 1 , Ken Butcher 1
  1. Prince of Wales Hospital, Randwick, NSW, Australia
  2. Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
  3. Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia
  4. Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
  5. Department of Neurology, Nepean Hospital, Kingswood, NSW, Australia
  6. Department of Neurology, Wagga Hospital, Wagga Wagga, NSW, Australia

Background

While endovascular thrombectomy (EVT) is effective in large vessel occlusion (LVO) stroke, the utility of bridging thrombolysis has been questioned, particularly in patients presenting 4.5-24 hours after onset (‘late’ treatment window). We aimed to determine the efficacy of pre-thrombectomy thrombolysis in patients with respect to radiographic reperfusion and subsequent functional outcomes.

Methods

This was a retrospective cohort study of patients referred for EVT from regional (Telestroke) and metropolitan stroke centres between 1/1/2020 and 31/12026. Patients were categorized by thrombolysis status (IVT vs no IVT), with prespecified subgroup analyses performed in early (≤4.5 hours) and late (>4.5 hours) treatment windows. The primary outcome was pre-thrombectomy reperfusion (TICI≥2b). Propensity Score Overlap Weighting (PSOW) was applied to create a weighted cohort with balanced baseline covariates.

Results

1154 patients were included. In total 603 received IVT, in which 174 underwent late-window reperfusion. 551 did not receive IVT, in which 429 underwent late window reperfusion. IVT was associated with pre-thrombectomy reperfusion (PSOW-OR 15.2, [6.56, 35.0], p<0.001) in both early (PSOW-OR 7.06, [0.93, 53.46], p=0.028) and late windows (PSOW-OR 21.85, [7.47, 63.96], p<0.001). Thrombolysis was also associated with a favourable ordinal shift in 90-day mRS overall (PSOW-OR 1.69, [1.24, 2.33], p=0.001), most evident in the late-window (PSOW-OR 1.66, [1.03, 2.64], p=0.031). Symptomatic haemorrhagic transformation was not significantly increased in any group.

Conclusion

Bridging thrombolysis was associated with increased pre-thrombectomy reperfusion and improved functional outcomes up to 24 hours after onset in patients with confirmed vessel occlusion. Haemorrhagic transformation rates were unchanged in either time window.

  1. Turc G, Bhogal P, Fischer U, et al. European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg. 2019;11(6):535-538
  2. Majoie CB, Cavalcante F, Gralla J, et al; IRIS collaborators. Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials. Lancet. 2023;402(10406):965-974.