Document resource
Background Early thrombus modification after intravenous thrombolysis (IVT) may influence angiographic and clinical outcomes in anterior circulation large vessel occlusion stroke (LVOS). We evaluated the association between thrombolytic agent and thrombus movement phenotype, and the relationship between thrombus movement and 90-day functional outcome.Methods We performed a retrospective analysis of a prospectively maintained registry across two comprehensive stroke centers (January 2020-August 2024). Adult patients with anterior circulation LVOS (ICA, M1, or M2) treated with IVT within 4.5 hours and referred for endovascular therapy (EVT) were included. Thrombus movement was classified by comparing baseline (CT angiography) and follow-up (digital subtraction angiography) imaging into persistent occlusion, any clot effect (partial recanalization, distal migration, or fragmentation), or complete resolution. The primary outcomes were thrombus movement category and 90-day modified Rankin Scale (mRS 0-2). Multivariable logistic regression estimated adjusted odds ratios (aOR).Results Among 289 patients (median age 71 years; median NIHSS 16), 194 (67.1%) received tenecteplase and 95 (33.9%) alteplase. Persistent occlusion occurred in 82.0%, any clot effect in 16.9%, and complete resolution in 1.0%. Tenecteplase was associated with higher rates of any clot effect (22.2% vs. 6.3%, p=0.002) and independently predicted a more favorable thrombus movement category (aOR 2.85, 95% CI 1.29-7.05; p=0.015). Residual flow grade 1-2 also independently predicted favorable thrombus movement (aOR 2.52, 95% CI 1.28-4.94; p=0.007). Favorable thrombus movement was not associated with 90-day mRS 0-2. No significant interaction was observed between thrombolytic type and thrombus movement on functional outcome. Final successful reperfusion grades did not differ significantly between groups, with 94.5% of patients with persistent occlusion achieving successful reperfusion compared with 100% in the other groups (p=0.246).Conclusions In anterior circulation LVOS, tenecteplase was independently associated with greater early thrombus movement before EVT compared with alteplase. In this cohort thrombus movement category did not predict 90-day clinical outcomes and thrombolytic type did not mediate thrombus movement category and clincial outcomes. Similar final reperfusion grades may partially account for the absence of clinical differences.Disclosures K. Darko: None. K.E. Kline: None. V. Bohl: None. G. Badger: None. T.M. Bielinski: None. O. Goren: None. C. Schirmer: None. P. Hendrix: None.Abstract E-091 Figure 1