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

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