Abstract Number: Esoc2026a906 Comparative Efficacy and Safety of Combined Intravenous Alteplase and Endovascular Treatment Versus Direct Endovascular Treatment in Acute Basilar Artery Occlusion

Abstract Background and aims Currently, there are inconclusive and conflicting conclusions regarding the comparison between EVT and standard medical treatment in BAO patients.This study aimed to compare the functional outcomes between endovascular treatment (EVT) with and without intravenous thrombolysis (IVT) first in patients who had acute basilar artery occlusion (BAO). Methods BAO patients who underwent EVT within 24 hours of onset were enrolled in Neurological Institute of Thailand between July 1, 2015 to August 31, 2023, and the efficacy and safety were compared between IVT+EVT and direct EVT (DEVT). The primary outcome was 90-day functional independence.All outcomes were assessed with adjusted OR (aOR) from the multivariable logistic regression. Results Of 93 enrolled patients with BAO, 53 (57%) were treated with DEVT and 40 (43%) with IVT+EVT. Successful mTICI≥2b post-EVT higher in patients treated with IVT+EVT (82.5% vs 62.3%, p0.05) (aOR, 3.12; 95% CI, 1.01-9.62; p=0.047). IVT+EVT was associated with a good functional outcome of mRS 0-2 at 90 days (aOR, 1.58; 95% CI, 0.59-4.26; p=0.365) but higher mortality at 90 days (aOR, 1.34; 95% CI, 0.31-5.84; p=0.700) without statistical significance. Conclusions This study demonstrated that, compared with DEVT, EVT with IVT first was associated with similar functional outcomes at 3 months in patients with BAO. The successful reperfusion rate (mTICI2b-3) in EVT with IVT first was significantly higher than DEVT and showed a tendency towards more improved functional outcomes at 3 months in EVT with IVT first. Conflict of interest Thanaboon: nothing to disclose