Outcomes of Endovascular Thrombectomy with and without thrombolysis for acute large artery ischaemic stroke at a Tertiary Stroke Centre (P5.259)

Objective: To compare the safety and effectiveness of standard care of acute large artery ischaemic stroke by EVT plus thrombolysis with that of EVT alone in a tertiary hospital stroke service. Background: Endovascular thrombectomy (EVT) has been shown in 5 recent randomised trials to improve functional outcome when added to best medical therapy in patients with acute ischaemic stroke secondary to large vessel occlusion(LVO) in the anterior circulation. However, direct evidence for EVT in alteplase ineligible patients in limited. Also uncertain is whether the treatment effect of EVT is so powerful that bridging alteplase may not add to the efficacy and may even compromise safety by increasing bleeding risks. Design/Methods: We performed a retrospective analysis of acute ischemic stroke patients treated with EVT at our centre between October 2013 and April 2016. Individual patient records were retrieved for data collection. Significant early neurological improvement was defined as a NIHSS score of 0–1 or a decrease of £ 8 at 24 hours. Results: 50 patients with acute ischaemic stroke secondary to LVO in the anterior circulation received EVT in this period, 21 received concurrent alteplase and 29 EVT alone. Outcomes were similar in both groups, 47.6% of patients with bridging alteplase and 51.7% of patients with EVT alone showed significant neurological improvement at 24h p=0.774. Adverse events were similar between both groups. Inpatient mortality was 20% vs. 7.1%, p=0.184 and intracranial haemorrhages 14.3% vs. 20.7%, p=0.716 in bridging alteplase and EVT alone patients respectively. Conclusions: Our study supports the use of direct EVT for patients in whom alteplase is contraindicated. We observed no additional benefit of adding intravenous thrombolysis to EVT but the estimates are imprecise due to small numbers. Nevertheless, the results are consistent with observational data from other centres, and support a randomised controlled trial of EVT vs. EVT with bridging alteplase. Disclosure: Dr. Wee has nothing to disclose. Dr. Hankey has received personal compensation for activities with Bayer Pharmaceuticals and theheart.org (Medscape) as a speaker.