Background: Combination of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) is still the standard of care for select patients with acute large vessel occlusion (LVO) stroke within 4.5-hours of last known well (LKW). However, the impact of bridging therapy on clinical outcomes for eligible patients who present directly to comprehensive stroke centers (CSC) remains controversial. <break><break> Methods: This is a retrospective cohort obtained from Get With The Guidelines-Stroke Database available at the Medical University of South Carolina CSC for LVO patients who presented within 4.5 hours of LKW between January/2018 and June/2022. This study aimed to evaluate the benefit of IVT in reducing the final infarction volume (FIV) after complete recanalization.<break><break>Results: Of 220 patients who presented with LVO and had complete recanalization (mTICI2c/3), 100 (45%) arrived within 4.5 hours of LKW and 39 patients (39%) received IVT in addition to mechanical thrombectomy (IVT-MT). IVT-MT group had a smaller final infarct volume (FIV) than the MT-only group (7cc vs.16 cc, p=0.03). IVT was associated with 26cc reduction in FIV 95%CI [-45.7, -6.80), p=0.009). This effect was modified by the Collaterals score for anterior LVO 11cc 95%CI [-20.33- -1.92]. FIV influenced discharge NIHSS 3.095 95%CI [0.030-0.136], p= 0.003, and 90-day functional independence mRS (0-2) aOR 0.98 95%CI [0.96-0.99], p=0.022. Consequently, the IV-MT group had better 24-hours NIHSS 2 IQR (0-5) vs. 6 (2-13) p= 0.034, better discharge NIHSS 2 IQR (0-2) vs. 4 (1-11) p= 0.048, and more proportion of patients achieved functional independence at 90-days 32% vs. 10% however this difference did not reach statistical significance p=0.41. <break><break>Conclusion: This study suggests that the combined IVT-MT approach can benefit LVO patients beyond the drip and ship model. IVT potentiates the effect of successful recanalization via the reduction of FIV and subsequent improved outcomes

The authors have declared no competing interest.

This is a retrospective cohort and was not registered in clinicaltrials.gov

Funding was through the department of neurology at MUSC

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