Document resource
Background The safety of intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS) and a history of stable or unruptured arteriovenous malformations (AVMs) remains uncertain. This study aimed to assess the safety of IVT in AIS patients with underlying unruptured AVMs, including those who did and did not undergo endovascular thrombectomy (EVT).Methods We conducted a retrospective cohort study using the 2016-2022 Nationwide Readmissions Database. Patients with a known history of AVM who presented with AIS were identified. Using a multivariable logistic regression model, outcomes were compared between patients who received IVT and those who did not. A secondary analysis was performed, excluding patients who underwent EVT.Results Among 2009 selected patients with a history of AVM, 212 (10.6%) received IVT. There were no statistically significant differences between the IVT and non-IVT groups in routine discharge (OR 1.41, 95% CI 0.88-2.25), mortality (OR 0.716, 95% CI 0.248-2.07), or ICH (OR 0.76, 95% CI 0.37-1.55). Length of stay was also not significantly different (OR 0.96, 95% CI 0.77-1.20). These findings remained consistent after excluding patients who underwent EVT.Conclusions IVT in patients with unruptured AVMs was not associated with increased rates of mortality, ICH, or differences in discharge disposition or length of stay. These results were consistent regardless of EVT use.Disclosures L. Franco Castro: None. M.K. McIntyre: None. H. Chen: None. D. Gandhi: None. D. Lakhani: None. A. Malhotra: None. M. Colasurdo: None.