Abstract TP149: The Effects of Intravenous Thrombolysis on Distal Migration of Clots and Recanalization in Acute Ischemic Strokes Also Treated With Endovascular Therapies

• Published in: Stroke (1970) 2019-02, Vol.50 (Suppl_1)
• Main Authors: Cobia, Miles, Albright, Karen C, Foreman, Paul, Schmalz, Phillip, Gropen, Toby, Harrigan, Mark
• Format: Article
• Language: English
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.50.suppl_1.TP149

Abstract only Introduction: The role of intravenous recombinant tissue plasminogen activator (IV r-tPA) prior to endovascular therapy (ET) in acute ischemic stroke (AIS) has been heavily debated in recent literature. Understanding the direct relationship of IV r-tPA to occlusive thrombus size and migration may lead to further understanding of the potential benefits of IV r-tPA in AIS cases treated with ET. Methods: We retrospectively studied consecutive AIS patients who underwent a CT angiogram (CTA) followed by ET at our center from 7/2016-1/2017. We compared demographic, clinical, and imaging characteristics between subjects treated with or without IV r-tPA. Three raters, blind to IV r-tPA exposure, independently evaluated clot burden and location of each thrombus on CTA in comparison to digital subtraction angiography (DSA) images. Results: Among 29 patients meeting inclusion/exclusion criteria, 16 received IV r-tPA prior to ET and 13 received ET alone. Agreement among raters ranged from 0.296 (clot burden score of thrombus on DSA) to 0.800 (location of thrombus on CTA). There were no statistically significant differences in the treated and untreated groups (Table). The odds of distal migration of clot or recanalization on subsequent DSA among tPA treated patients was more than 4 times that of non-tPA treated patients (OR 4.28, 95% CI 0.71, 25.92). Conclusion: In summary, 43.8% of patients in the IV r-tPA plus ET treated group exhibited distal migration of a thrombus or recanalization when observed on DSA, compared to 15.4% in the ET-only group. Although our results suggest that IV r-tPA may change the size and location of the thrombus, our results were not adequately powered to detect significant differences. However, the inter-rater reliability was favorable, suggesting that this investigational technique may be successfully applied to a larger sample size in future studies investigating the role of IV r-tPA bridging therapy in AIS treated with ET.