Logo image
Back
1030 Time-Independent Value of IV TPA in Stroke Thrombectomy: Evidence From a Multicenter Cohort
Abstract   Peer reviewed

1030 Time-Independent Value of IV TPA in Stroke Thrombectomy: Evidence From a Multicenter Cohort

Amir Shaban, Ariana Chacon, Francesca Giraudo, Edgar A. Samaniego, Jonathan A. Grossberg, Kaustubh Limaye, Tianwen Ma, Brian M. Howard, Pascal Jabbour, Ansaar Rai, …
Neurosurgery, Vol.72(Supplement_1), pp.182-183
04/2026
DOI: 10.1227/neu.0000000000003964_1030

View Online

Abstract

INTRODUCTION: While endovascular thrombectomy (EVT) has revolutionized treatment for acute ischemic stroke (AIS), the role of pre-EVT intravenous thrombolysis (IVT) remains debated. Recent trials comparing direct EVT to bridging therapy have yielded mixed results, often excluding patients treated beyond the 4.5-hour window and underrepresenting real-world populations. Consequently, the additive value of IVT (particularly in late presenting patients) remains unclear. METHODS: We retrospectively analyzed data from AIS patients with anterior circulation LVO treated at 46 international stroke centers between January 2013 and December 2024. Adults aged ≥18 were included regardless of IVT status and categorized into early-window (≤4.5 hours) and late-window (>4.5 hours) groups based on time to arterial puncture. Outcomes included successful recanalization, distal embolization, symptomatic intracranial hemorrhage (sICH), and functional independence (90-day mRS 0–2). Multivariable logistic regression and propensity score matching were used to adjust for baseline and procedural differences. RESULTS: Among 15,998 patients reviewed, 7,854 met inclusion criteria. In adjusted analyses, IVT was associated with better recanalization (aOR = 1.57, P < 0.001) and functional independence (aOR = 1.52, P < 0.001) in the early window, along with increased distal embolization (aOR = 1.16, P < 0.001) but no significant rise in sICH (P = 0.25). In the late window, IVT remained beneficial for recanalization (aOR = 1.15, P = 0.003) and good outcomes (aOR = 1.11, P = 0.03), despite a higher sICH risk (aOR = 1.26, P < 0.001). On propensity-matched analysis of patients undergoing IVT, early-window therapy was associated with higher rates of distal embolization (OR = 1.44, p = 0.02) and improved functional outcomes (OR = 1.53, p < 0.001), with no significant differences in sICH (p = 0.09) or recanalization (p = 0.73). CONCLUSIONS: IV thrombolysis significantly improves outcomes when combined with EVT, both within and beyond 4.5 hours. These findings support the continued use of IVT in eligible patients, emphasizing its value across time windows including populations not represented in prior trials.

Details

Metrics

1 Record Views
Logo image