O-021 Endovascular treatment significantly improves outcomes compared to IV thrombolysis for strokes secondary to large vessel occlusions. 8-year experience

Introduction New thrombectomy devices for acute ischemic stroke (AIS) may allow endovascular therapy (EVT) to gain traction. However for EVT to have a significant impact on stroke it has to demonstrate improved functional outcomes compared to the conclusively proven IV rt-PA (IVT) administration. Literature supports a higher efficacy of EVT for proximal vessel occlusions. The goal of the current undertaking was to compare EVT and IVT for AIS. Methods We analyzed our prospectively maintained database of 425 patients for stroke treatments over an almost 8-year period. Only patients with a documented intracranial vascular occlusion in the anterior circulation on the baseline CTA who had undergone either EVT or IVT, but not both were included. A large vessel was defined as either the internal carotid artery terminus (ICA-T), the middle cerebral artery main stem with or without bifurcation involvement (M1) or isolated involvement of the proximal M2 branches (M2). A good clinical outcome was defined as mRS≤2. Results 225 patients were anayzed (IVT=101, EVT=124). The baseline NIHSS of 16.1(±7.6) was not different between the two groups (p=0.9). Patients in the IVT-group were older (76.2±12.7 years) than the EVT-group (68.1±17.2 years), (p=0.0001). Lower baseline NIHSS (p Conclusion This large study of over 200 patients concludes that patients presenting with AIS secondary to a large vessel occlusion in the anterior circulation have significantly higher odds of a favorable outcome with EVT as opposed to IVT. Our data supports the rationale of a randomized trial with head-to-head comparison of EV vs IV therapy for large vessel occlusions. Competing interests A Rai: Stryker Neurovascular. J Carpenter: Codman Neurovascular, Genetech. T Roberts: None. D Rodgers: None.