Abstract Number: Esoc2026a1311 Bridging Therapy Versus Direct Thrombectomy in Cardioembolic Acute Ischemic Stroke Patients With Middle Cerebral Artery Occlusion

Abstract Background and aims Cardioembolic acute ischemic stroke (AIS) is a leading global cause of disability and mortality, with endovascular treatment (EVT) as the first-line strategy for large vessel occlusion (LVO). However, the optimal EVT approach—bridging therapy (intravenous thrombolysis IVT followed by EVT) versus direct EVT—remains controversial in this specific patient population. Methods We conducted a multicenter observational study of AIS patients with middle cerebral artery occlusion (MCAO), symptom onset-to-hospital arrival within 24 hours, and cardioembolic etiology (per TOAST classification), who underwent either bridging therapy or direct thrombectomy. Eligible patients were 1:1 propensity score-matched (PSM). The primary outcome was a 90-day modified Rankin Scale (mRS) score of 0–2. Secondary outcomes included 90-day mRS score of 0–1, early neurological deterioration (END), and 90-day all-cause mortality. Results A total of 691 patients were enrolled (230 bridging therapy; 461 direct thrombectomy). After PSM, 422 matched patients were analyzed. No significant between-group differences were observed in 90-day mRS 0–2 (44.23% versus 43.20%; P=0.83), 90-day mRS 0–1 (32.85% versus 36.59%; P=0.43), or END (10.48% versus 7.62%; P=0.31). However, the bridging therapy group had significantly lower 90-day all-cause mortality than the direct thrombectomy group (18.11% versus 34.04%; odds ratio, 0.43 95% CI, 0.23-0.80; P = 0.008). Conclusions For cardioembolic AIS patients with MCAO, bridging and direct thrombectomy yield comparable functional outcomes, while bridging therapy is associated with a reduced 90-day mortality rate. Conflict of interest All authors: nothing to disclose