Intravenous Thrombolysis (IV tPA) Prior to Basilar Artery Thrombectomy, Analysis of the PC-SEARCH Registry
Ehad Afreen1, Adam Mierzwa2, Syed Zaidi3, Khaled Gharaibeh4, Nameer Aladamat5, Sami Al Kasab6, Ashley Nelson7, Santiago Ortega Gutierrez8, Mudassir Farooqui8, Juan Vivanco-Suarez8, Ashutosh Jadhav9, Shashvat Desai10, Gabor Toth11, Anas Alrohimi12, Thanh Nguyen13, Piers Klein14, Mohamad Abdalkader13, Aditya Pandey15, Sravanthi Koduri15, Shivangi Vora16, Nirav Vora16, Mouhammad Jumaa3, Hisham Salahuddin17
1Promedica Physicians Group Neurology, 2Promedica, 3ProMedica Stroke Network, 4ProMedica Neurosciences Center, 5The University of Toledo, 6Medical Univerity of South Carolina, 7Medical University of South Carolina, 8University of Iowa, 9University of Pittsburgh, 10University of Pittsburgh Medical Center, 11Cleveland Clinic Foundation, 12University of Alberta, 13Boston Medical College, 14Boston University, 15University of Michigan, 16Ohio Health, 17Vascular Neurology of Southern California
Objective:

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

Background:
The combination of intravenous tissue plasminogen activator (IV-tPA) and mechanical thrombectomy (MT) of the anterior circulation has been studied in large randomized clinical trials.  However, data on the safety and efficacy of IV-tPA in combination with MT for basilar artery occlusions is limited.
Design/Methods:

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.

Results:

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).

Conclusions:

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.  

10.1212/WNL.0000000000204257