Neurology. 2025 Apr 8;104(7_Supplement_1):4239. doi: 10.1212/WNL.0000000000211541. Epub 2025 Apr 7.
ABSTRACT
OBJECTIVE: To investigate the interaction between intravenous thrombolysis (IVT) and transfer strategies (mothership vs. transfer) on outcomes following endovascular thrombectomy (EVT) for vertebrobasilar artery occlusions (VBAOs).
BACKGROUND: EVT has become a standard intervention for acute ischemic stroke caused by VBAOs.
DESIGN/METHODS: A retrospective analysis was conducted on VBAO patients who underwent EVT. Patients were categorized based on treatment type: IVT followed by EVT or EVT alone. Transfer strategies were classified as mothership or transfer. The primary outcomes were modified Rankin Scale (mRS≤3) and mortality at 90 days.
RESULTS: Among 175 patients, the median age was 67 years with 54.9% males. Among these, 33 patients (18.9%) received IVT before EVT, while 142 (81.1%) underwent EVT alone. Among all patients, 48 (27.4%) presented as mothership, and 127 (72.6%) were transfers. In bridging IVT cohort, mRS≤ 3 at 90 days was observed in 58.3% of the mothership group, a higher rate compared to 38.9% in the transfer group. For EVT alone cohort, the mothership group demonstrated a lower rate of mRS≤ 3 at 90 days (35.3%) compared to transfer (45.8%). The mothership group in the IVT cohort had a 90-day mortality rate of 41.7% compared to 50.0% in the transfer group, while for patients undergoing EVT alone, the mothership group had a mortality rate of 52.9% versus 43.8% in the transfer group. Interaction analysis indicated that the mothership strategy may have more pronounced benefits for IVT-refractory patients; however, the overall interaction effect was not statistically significant (p>0.05).
CONCLUSIONS: In patients with VBAOs undergoing EVT, bridging IVT showed better clinical outcomes in the mothership group compared to those transferred from outside hospitals, particularly in contrast to the EVT-alone group. These findings suggest that the mothership strategy may benefit patients who are potentially IVT-refractory. Further studies with larger sample sizes are needed to confirm these results. Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff. Disclosure: Mr. Doheim has nothing to disclose. Dr. Rios Rocha has nothing to disclose. Abdullah Al Qudah has nothing to disclose. Miss Almast has nothing to disclose. Dr. Starr has nothing to disclose. The institution of Dr. Rocha has received research support from NIH. Dr. Bhatt has nothing to disclose. Dr. Correia Lima has nothing to disclose. Dr. Gross has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Gross has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Microvention. Dr. Gross has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. Dr. Lang has nothing to disclose. Dr. Nogueira has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron (consulting fees) as well as for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze ( stock options). Dr. Nogueira has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law Firms. Dr. Nogueira has received stock or an ownership interest from Viz-AI, Perfuze, Cerebrotech, Reist/Q’Apel Medical, Truvic, and Viseon. The institution of Dr. Nogueira has received research support from Cerenovus. Dr. Al-Bayati has nothing to disclose.
PMID:40194219 | DOI:10.1212/WNL.0000000000211541
