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Abstract Details

Intravenous Thrombolysis (IV tPA) Prior to Basilar Artery Thrombectomy, Analysis of the PC-SEARCH Registry
Cerebrovascular Disease and Interventional Neurology
S24 - Cerebrovascular Disease and Interventional Neurology: Endovascular Thrombectomy and Large Vessel Occlusions (2:48 PM-3:00 PM)
010
The combination of intravenous tissue plasminogen activator (IV-tPA) and mechanical thrombectomy (MT) of the anterior circulation has been studied in large randomized clinical trials.  However, data on the safety and efficacy of IV-tPA in combination with MT for basilar artery occlusions is limited.

We aim to determine the safety and efficacy of intravenous tPA in patients with basilar artery occlusions treated with mechanical thrombectomy.

PC-SEARCH is a multicenter retrospective registry of consecutive patients who underwent MT  for basilar artery occlusion between July 2015 – December 2021. Patients from the registry were included in the study if they presented to hospital within 4.5 hours of symptom onset. Recorded variables included baseline characteristics, procedural data, radiographic and clinical outcomes. Good clinical outcomes was defined as mRS ≤ 3 at 90 days.  Multivariate logistic regression models were used to identify predictors of good clinical outcome.

A total of 519 patients were enrolled in the PC-SEARCH registry of which 218 patients arrived to hospital within 4.5 hours of presentation.  IV-tPA was administered to 99 (45%) of these patients. Baseline demographics including age, gender, and baseline risk factors were similar between the two groups with the exception of a lower NIHSS (16.5 vs. 18.1; p=0.05) and more frequent history of previous stroke in the IV-tPA group (26.1% vs. 10.1%; p=0.002).  PC-ASPECTS, rates of successful recanalization, mortality, and good clinical outcomes (43.7% vs. 49.5%; p=0.38) were also comparable between the two groups. Multivariate analysis revealed that IV-tPA prior to MT was not a predictor of outcome at 90 days (OR 1.74, CI 0.81 – 3.71; p=0.16).

In patients with basilar artery occlusions, IV-tPA administration prior to MT appears to be safe but did not impact clinical outcomes at 90 days.  Further studies are warranted.  

Authors/Disclosures
Ehad Afreen, MD (Promedica Physicians Group Neurology)
PRESENTER
Dr. Afreen has nothing to disclose.
Adam T. Mierzwa, MD (Promedica) Dr. Mierzwa has nothing to disclose.
Syed F. Zaidi, MD (ProMedica Stroke Network) Dr. Zaidi has nothing to disclose.
Khaled Gharaibeh, MD (ProMedica Neurosciences Center) Dr. Gharaibeh has nothing to disclose.
Nameer Aladamat, MBBS (The University of Toledo) Dr. Aladamat has nothing to disclose.
Sami Alkasab, MD (University of Iowa) No disclosure on file
Ashley Nelson, DO (Medical University of South Carolina) Dr. Nelson has nothing to disclose.
Santiago Ortega Gutierrez, MD (University of Iowa) Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for microvention. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH.
Mudassir Farooqui, MD Dr. Farooqui has nothing to disclose.
Juan A. Vivanco-Suarez, MD Mr. Vivanco-Suarez has nothing to disclose.
Ashutosh P. Jadhav, MD, FAAN (Barrow Neurological Institute) Dr. Jadhav has nothing to disclose.
Shashvat Desai, MD (University of Pittsburgh Medical Center) Dr. Desai has nothing to disclose.
Gabor Toth, MD (Cleveland Clinic Foundation) Dr. Toth has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Dynamed. Dr. Toth has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic.
Anas Mohammed Alrohimi, MD (University of Alberta) Dr. Alrohimi has nothing to disclose.
Thanh Ngoc Nguyen, MD Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Vesalio. Dr. Nguyen has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for NIH. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Avania. Dr. Nguyen has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. The institution of Dr. Nguyen has received research support from Boston Medical Center. The institution of Dr. Nguyen has received research support from Society of Vascular and Interventional Neurology.
Piers Klein Mr. Klein has nothing to disclose.
Mohamad Abdalkader (Boston Medical Center Deptartment Of Radiology) Mohamad Abdalkader has nothing to disclose.
Aditya S. Pandey, MD (University of Michigan) Dr. Pandey has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NIH and SVIN- Journal. Dr. Pandey has stock in FlexDex. Dr. Pandey has stock in NextGen. The institution of Dr. Pandey has received research support from NIH. The institution of Dr. Pandey has received research support from Focused ultrasound foundation. Dr. Pandey has received intellectual property interests from a discovery or technology relating to health care.
Sravanthi Koduri No disclosure on file
Shivangi *use 121636 Vora No disclosure on file
Nirav Vora, MD No disclosure on file
Mouhammad A. Jumaa, MD (ProMedica Stroke Network) Dr. Jumaa has nothing to disclose.
Hisham Raza Alim Salahuddin, MD (Vascular Neurology of Southern California) Dr. Salahuddin has nothing to disclose.