Receipt Of Intravenous Thrombolysis Is Strongly Associated With 90 Day Functional Outcomes For Large Vessel Occlusion Stroke Patients Undergoing Endovascular Therapy

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Introduction: Endovascular thrombectomy (EVT) is the standard of care for the treatment of large vessel occlusion stroke (LVOS). Most patients arrive at an endovascular center (ESC) either directly by EMS or by transfer from a non-ESC hospital. Many LVOS patients receive intravenous thrombolysis (IVT) prior to EVT. However, the benefits of IVT in combination with EVT are uncertain. The effect of direct transport to an ESC for EVT (primary) versus patients transferred for EVT (secondary) is also uncertain. Our goal was to determine the association between the IVT, primary transport versus secondary transport, and 90-day functional outcomes in LVOS patients treated with EVT. Methods: This study is an analysis of the Optimizing Prehospital Stroke Systems of Care-Reacting to Changing Paradigm (OPUS-REACH) registry. The registry includes 2400 LVOS patients who underwent EVT from nine health systems in the United States. We included all patients with LVOS who arrived by EMS and had a last known well time to EVT of less than 10 hours. Results: 1171 patients were included in the analysis and 39.5% of patients had good outcomes at 90 days (mRS score of 0-2). We found a 9% improvement in good outcomes when patients received IVT prior to EVT (OR 1.65, 95% CI 1.31-2.07). This association held true up to 10 hours (Figure 1) and in both patients who were transported directly to an ESC and in those patients transferred from a non-ESC. Conclusion: This investigation supports the importance of LVOS patients receiving IVT prior to EVT treatment as it was associated with markedly better outcomes (NNT=9). Prehospital transport algorithms should maximize access to IVT even if it delays time to EVT.

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