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December 6, 2025Open Access

Abstract 364: Bridging With Intravenous Thrombolysis Before Endovascular Therapy Versus Endovascular Therapy Alone In Patients Aged 80 And Older

Key Points

Bridging therapy did not improve functional outcomes in elderly acute ischemic stroke patients, showing similar 90-day mRS scores.
The study involved a cohort of 295 patients, with no significant differences found in key outcomes including symptomatic intracranial hemorrhage rates.
Retrospective cohort study utilized adjusted logistic regression to analyze outcomes related to bridging and endovascular therapy alone.
Findings suggest that individualized IVT decisions should be based on patient risk profiles and clinical considerations.

Abstract

Introduction/Purpose Endovascular thrombectomy (EVT) is the standard of care for acute ischemic stroke (AIS) due to large vessel occlusion (LVO). The role of intravenous thrombolysis (IVT) prior to EVT—commonly referred to as bridging therapy—remains controversial in elderly patients because of concerns regarding an increased risk of symptomatic intracranial hemorrhage (sICH). This study aims to compare the safety and efficacy of bridging therapy (IVT + EVT) versus EVT alone in patients aged ≥80 years. Materials/Methods We conducted a retrospective cohort study for AIS patients, aged ≥80 years, with LVO who underwent EVT (2021‐2025). Adjusted logistic regression models were used to estimate odds ratios (aOR) for key outcomes: improvement in 90‐day mRS scores, favorable outcomes (mRS 0‐2 or return to baseline), sICH, complete recanalization (TICI 3), and successful recanalization (TICI ≥2b). Results Among 295 patients, 71 received bridging IVT and 224 underwent EVT alone. The bridging IVT group had a significantly shorter hospital arrival time (187 IQR: 115‐259 minutes vs. 449 IQR: 230‐806 minutes), higher proportion of females (81.7% vs. 68.3%), and a lower prevalence of atrial fibrillation (49.3% vs. 68.8%). After adjusting for baseline confounders, bridging therapy was not significantly associated with any key outcomes: 90‐day mRS scores (aORFM1 0.94, 95% CI: 0.50‐1.75, p=0.84), favorable outcomes (aOR 1.00, 95% CI: 0.46‐2.17, p=0.99), sICH (aOR 1.12, 95% CI: 0.30‐4.21, p=0.87), complete recanalization (aOR 0.91, 95% CI: 0.50‐1.64, p=0.74), or successful recanalization (aOR 1.00, 95% CI: 0.29‐3.45, p=0.99). Conclusion In this cohort of patients beyond octogenarians, bridging therapy with IVT prior to EVT was not independently associated with improved functional outcomes, including shifts in 90‐day mRS scores, nor with higher rates of recanalization. Importantly, it did not significantly increase the risk of symptomatic intracranial hemorrhage after adjustment for baseline characteristics. These findings suggest that EVT alone may be a safe and effective treatment strategy for elderly patients, particularly those presenting beyond the IVT time window or with contraindications to thrombolysis. IVT decisions in this population should be individualized, based on clinical presentation, symptom onset timing, and overall risk profile. image

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