Abstract Number: Esoc2026a2255 Safety and Efficacy of Bridging Therapy Up to 24 Hours Versus Direct Thrombectomy in Basilar Artery Occlusion: A Propensity Score-Matched Analysis in an Asian Cohort

Abstract Background and aims In basilar artery occlusion (BAO), the benefit of bridging therapy (IVT+EVT) versus direct EVT (DEVT) in extended windows remains controversial. Evidence is scarce for Asian populations characterized by high Intracranial Atherosclerotic Disease (ICAD) and transport delays. We compared the safety and efficacy of bridging therapy versus DEVT in an extended window using propensity score matching (PSM). Methods This multicenter study analyzed 307 consecutive BAO patients (2021–2025). Our protocol permitted Alteplase up to 24 hours guided by multimodal imaging, analogous to EVT protocols; notably, 42% of bridging patients were treated beyond 4.5 hours. We performed 1:1 PSM based on age, NIHSS, PC-ASPECTS, and onset-to-puncture time. The primary endpoint was 90-day functional independence (mRS 0-2). Results The cohort had high ICAD (65.5%) and severe deficits (median NIHSS 18). Median onset-to-puncture was 694 minutes. After PSM (85 pairs), the Bridging group achieved significantly higher functional independence than DEVT (37.6% vs 22.4%; p=0.030). Multivariate regression confirmed bridging as an independent predictor of favorable outcome (aOR 2.895; 95%CI 1.20-6.97, p=0.018). Recanalization rates were similar (81.2% vs 78.8%, p=0.701). Regarding safety, despite the high ICAD burden and extended window, rates of symptomatic intracranial hemorrhage were comparable (5.9% vs 4.7%, p=0.687), as was 90-day mortality (38.8% vs 43.5%, p=0.533). Conclusions In this Asian BAO cohort, bridging therapy significantly improved functional outcomes with comparable safety, even when administered up to 24 hours. These real-world data may support bridging therapy as the preferred strategy for eligible BAO patients, particularly in populations with atherosclerotic predominance. Conflict of interest An Thai Thanh Nguyen: nothing to disclose, Phuong Tien Pham: nothing to disclose, BINH NGUYEN PHAM: nothing to disclose, Huy Thang Nguyen: nothing to disclose