Abstract Details

We aim to determine the safety and efficacy of intravenous tPA in patients with basilar artery occlusions treated with mechanical thrombectomy.

PC-SEARCH is a multicenter retrospective registry of consecutive patients who underwent MT  for basilar artery occlusion between July 2015 – December 2021. Patients from the registry were included in the study if they presented to hospital within 4.5 hours of symptom onset. Recorded variables included baseline characteristics, procedural data, radiographic and clinical outcomes. Good clinical outcomes was defined as mRS ≤ 3 at 90 days.  Multivariate logistic regression models were used to identify predictors of good clinical outcome.

A total of 519 patients were enrolled in the PC-SEARCH registry of which 218 patients arrived to hospital within 4.5 hours of presentation.  IV-tPA was administered to 99 (45%) of these patients. Baseline demographics including age, gender, and baseline risk factors were similar between the two groups with the exception of a lower NIHSS (16.5 vs. 18.1; p=0.05) and more frequent history of previous stroke in the IV-tPA group (26.1% vs. 10.1%; p=0.002).  PC-ASPECTS, rates of successful recanalization, mortality, and good clinical outcomes (43.7% vs. 49.5%; p=0.38) were also comparable between the two groups. Multivariate analysis revealed that IV-tPA prior to MT was not a predictor of outcome at 90 days (OR 1.74, CI 0.81 – 3.71; p=0.16).

In patients with basilar artery occlusions, IV-tPA administration prior to MT appears to be safe but did not impact clinical outcomes at 90 days.  Further studies are warranted.