Abstract TP20: Intravenous thrombolysis versus early antiplatelet therapy in acute Ischemic Stroke with Small Artery Occlusion

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Backgrounds: There remained a debate about the efficacy and safety of intravenous thrombolysis (IVT) on functional outcome compared to early antiplatelet therapy for ischemic stroke patients with small artery occlusive (SAO), and whether it could reduce the occurrence of early neurological deterioration (END) in the acute phase. Methods: Ischemic stroke patients with SAO who received IVT or early antiplatelet therapy only were screened from a prospective, multi-center ischemic stroke registry study from January 2021 to June 2021. The primary outcome was 3-month functional outcome by modified Rankin scale (mRS). The secondary outcome was symptomatic intracerebral hemorrhage (sICH) and END defined as an increase in total National Institute of Health stroke scale score (NIHSS) ≧ 2 points or in motor score ≧1 points within 7 days after admission. Results: A total of 1,125 patients with SAO were finally included (394 received IVT and 731 received early antiplatelet therapy), 411 (36.5%) experienced unfavorable outcomes (mRS > 2) at three months, sICH occurred in 3 patients (0.27%), all within the IVT group. Additionally, 213 patients (18.9%) experienced END. After propensity score matching and multivariable adjustment, IVT was significantly associated with a reduced likelihood of unfavorable outcomes at 3 months (adjusted odds ratio [aOR] 0.447, 95% CI 0.305–0.656), with no significant difference in END (aOR 0.867, 95% CI 0.569–1.321). Subgroup analysis indicated that patients with elevated traditional risk factors derived more benefit from IVT compared to those with high inflammatory response markers (aOR 0.405, 95% CI 0.244–0.673) on functional outcomes. Conclusion: IVT was associated with reduced incidence of unfavorable outcomes at three months, but failed to prevent END during hospitalization in SAO stroke patients. Patients with elevated traditional risk factors at admission may benefit more from thrombolytic therapy compared to those with high inflammatory response indicators.

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