Abstract Details

Title Intravenous Thrombolysis Alone versus Endovascular Thrombectomy Alone versus Intravenous Thrombolysis plus Endovascular Thrombectomy for Ischemic Stroke Beyond the 4.5-Hour Window: A Network Meta-Analysis of Randomized Clinical Trials

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P7 - Poster Session 7 (5:00 PM-6:00 PM)

Poster/Presentation
Number 13-004

Objective To compare the efficacy and safety of intravenous thrombolysis (IVT), endovascular thrombectomy (EVT), and the combined approach for acute ischemic stroke beyond 4.5 hours.

Background Few stroke patients qualify for IVT within the 4.5-hour window. Recent studies have revolutionized the eligibility criteria to extend the EVT window beyond 6 hours. Limited data compare these treatment approaches beyond 4.5 hours.

Design/Methods We systematically searched Pubmed, Embase, Cochrane, and Web-of-Science for randomized clinical trials (RCTs) analyzing IVT and/or EVT versus control in ischemic stroke beyond 4.5 hours of last-known-well. Primary outcomes were functional outcomes according to modified Rankin Scale (mRS) at 90 days, classified as excellent (0-1) or good (0-2), symptomatic intracerebral hemorrhage (sICH), and mortality at 90 days. We used frequentist and Bayesian network meta-analysis models, reporting odds ratios (ORs) with 95% confidence intervals (CIs) from the Bayesian analysis.

Results Thirteen RCTs (3,668 patients; mean age 67.4±9.4 years, 56.5% male) were included. Compared to control, EVT alone achieved higher rates of excellent (OR, 2.22, 95% CI, 1.40-3.79) and good functional outcomes (OR, 2.70, 95% CI, 1.60-5.11), while IVT alone and IVT plus EVT were not statistically significant. IVT alone demonstrated a higher rate of sICH (OR, 6.10, 95% CI, 2.19-21.9) than EVT alone (OR, 2.64, 95% CI 1.01-7.08), and a non-significant increase in the combined approach (OR, 1.33, 95% CI 0.32-5.24). Mortality at 90 days did not significantly differ between treatment groups.

Conclusions Compared to control, EVT alone for ischemic stroke beyond the 4.5-hour window achieved higher odds of excellent and good functional outcomes and lower rates of sICH. IVT alone led to increased odds of sICH, with a non-significant increase in mortality. The combined therapy may not offer substantial benefits over the isolated approaches. Future RCTs are necessary to optimize patient selection for the combined approach and consolidate protocols in the extended time window.

Authors/Disclosures
Marina Vilardo PRESENTER	Miss Vilardo has nothing to disclose.
Lucas P. Mitre	Dr. Mitre has nothing to disclose.
AHMET GÜNKAN, MD	Dr. GÜNKAN has nothing to disclose.
Dominique H. Montecino, MD (Mayo Clinic)	Dr. Montecino has nothing to disclose.
Filipe V. Ribeiro, MD	Ms. Ribeiro has nothing to disclose.
Bruna Leles Vieira de Souza, MD (Work)	Miss Leles Vieira de Souza has nothing to disclose.
Ocilio R. Goncalves, MS	Mr. Goncalves has nothing to disclose.
Raphael Camerotte	Raphael Camerotte has nothing to disclose.
Ana Santos, MD	Ms. Santos has nothing to disclose.
Anthony Hong, MD	Dr. Hong has nothing to disclose.

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