Abstract Number: Esoc2026a1891 Outcomes After Bridging Thrombolysis in Endovascularly Treated Medium or Distal Vessel Occlusion Stroke - A Multicenter Cohort Study From the Eva-Trisp Collaboration

Abstract Background and aims Recent RCTs of EVT in medium- or distal-vessel occlusion (MDVO) strokes (DISTAL, ESCAPE-MeVO) reported neutral outcomes. As trials may not represent patients treated in the real world, we analyzed such patients in a large multicenter registry, comparing outcomes of bridging therapy (IVT+EVT) versus EVT-alone. Methods We retrospectively analyzed registry data from EVA-TRISP (17 stroke centers, 2014-2023). Adults with MDVO (M2–M4 MCA, ACA, PCA) treated with EVT with or without prior IVT were included. The primary outcome was the 90-day mRS distribution, analyzed with a mixed-effects proportional-odds model adjusted for age, pre-stroke mRS, baseline NIHSS, diabetes, hypertension, atrial fibrillation, and treatment year. Secondary outcomes were excellent (mRS0-1) and good (mRS0-2/return-to-premorbid) functional outcome, mortality, symptomatic intracranial haemorrhage, and successful recanalization (mTICI2b-3). Missing data were imputed; sensitivity analyses used complete-case and IPTW approaches. Results Among 3008 patients (median age 76, 45% of female sex, median NIHSS 10), 48% received bridging therapy. Adjusted analysis demonstrated better functional outcome (OR=1.60, 95%-CI 1.38-1.84, p 0.001), higher odds of excellent (OR=1.75 95%-CI 1.45-2.11) and good (OR=1.63 95%-CI 1.36-1.96) recovery, and lower mortality (OR=0.63 95%-CI 0.50-0.78). Symptomatic intracranial hemorrhage was modestly increased (5% vs. 3%; OR=1.68 95%-CI 1.13-2.51), while recanalization rates were comparable (70% vs. 69%; OR=1.07 95%-CI 0.89-1.28). Findings were consistent across complete-case and IPTW analyses. Conclusions These results suggest that, in real-world practice, adjunctive IVT may add benefit to EVT for MDVO-patients. Conflict of interest The author(s) received no financial support for the research, authorship, and/or publication of this abstract.