E-005 primary acute stroke thrombectomy within 3 hours from large artery occlusion (past3-lao) – a pilot study

Background: Based on recent trials, AIS due to large artery occlusion (LAO) is resistant to IV thrombolysis and adjunctive stent retriever thrombectomy (SRT) is associated with better recanalization rates and outcomes.Despite the benefit with endovascular therapy 39% to 68% of patients were either disabled or dead.Thrombectomy in AIS with LAO within 3 hours (IV t-PA window) is performed as secondary therapy after IV thrombolysis, which may be associated with delay in enrollment and recanalization. Objective: Primary objective is to evaluate the safety, feasibility and recanalization rate of primary SRT (without IV tPA) within 3 hours in AIS with NIHSS >10 from LAO.Secondary objective is to determine the functional outcome in 30-days and 90-days. Methods: Based on institutionally approved protocol patients with LAO with LCB within 3 hours were offered primary SRT alone as an alternative to IV rtPA, after informed consent.Consecutive patients who underwent primary SRT for LAO within 3 hours from 2012 to 2014 were enrolled.Outcomes were measured using modified Rankin Scale. Results: 18 patients with LAO; mean age 62.8±15.3 years and mean NIHSS 16±5; chose primary SRT after informed consent.Thrombectomy was performed using new generation stent-retriever device in addition to small intra-arterial rtPA (2-10 mg).Number of passes was 1.6±0.9.Near complete (TICI2b in 1) and complete (TICI3 in 17) recanalization was observed in all (100%) patients.Mean time to recanalization from symptoms onset was 188.5±82.7 and from groin puncture was 64.61±40.14 minutes.Immediate post-thrombectomy, 24 hour and 30 day NIHSS score was 4.4±3.7, 1.9±3.2 and 0.3±0.9 respectively.There was no procedure related complication.Asymptomatic perfusion related hemorrhage developed in 6 patients (33%).30 days good outcome was observed in all cases (mRS0= 38.9%, mRS1=44.4%, mRS2=16.7%). 90 days good outcome was observed as follows (mRS0= 50.0%, mRS1=44.4%, mRS2=5.6%). Conclusion: Our pilot study demonstrates that primary SRT in AIS due LAO occlusion with LCB is not only safe and feasible, but associated with complete recanalization and good functional outcome.Larger randomized controlled studies are needed.

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Prehospital Acute Stroke Severity Scale to Predict Large Artery Occlusion

Stroke ◽

10.1161/strokeaha.115.012482 ◽

2016 ◽

Vol 47 (7) ◽

pp. 1772-1776 ◽

Cited By ~ 103

Author(s):

Sidsel Hastrup ◽

Dorte Damgaard ◽

Søren Paaske Johnsen ◽

Grethe Andersen

Keyword(s):

Acute Stroke ◽

Artery Occlusion ◽

Stroke Severity ◽

Large Artery ◽

Severity Scale

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Response by Hastrup and Andersen to Letter Regarding Article, “Prehospital Acute Stroke Severity Scale to Predict Large Artery Occlusion: Design and Comparison With Other Scales”

Stroke ◽

10.1161/strokeaha.116.014620 ◽

2016 ◽

Vol 47 (9) ◽

Author(s):

Sidsel Hastrup ◽

Grethe Andersen

Keyword(s):

Acute Stroke ◽

Artery Occlusion ◽

Stroke Severity ◽

Large Artery ◽

Severity Scale

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Abstract 26: RACE to Treat Stroke

Stroke ◽

10.1161/str.47.suppl_1.26 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Andrea M Korsnack ◽

Andrea Adams

Keyword(s):

Endovascular Treatment ◽

Acute Stroke ◽

Arterial Occlusion ◽

First Responders ◽

Artery Occlusion ◽

Large Vessel ◽

Stroke Severity ◽

Large Artery ◽

Stroke Patients ◽

Conversion Disorders

Background: Endovascular treatment was shown to drastically improve stroke patient outcomes but earlier identification of eligible patients is crucial. First responders are instrumental to the rapid identification and transportation of stroke patients to the nearest appropriate facility for acute stroke care especially when endovascular intervention is an option. Purpose: To develop and evaluate the effectiveness of an algorithm for first responders to use to differentiate which stroke patients should be transported to the closest Interventional Stroke Center for treatment. Method: We revised the County-Level Emergency Medical Services (EMS) protocol and algorithm to include the Rapid Arterial oCclusion Evaluation (RACE) scale in addition to the Cincinnati Prehospital Stroke Scale (CPPS). Together these simple in-the-field scales assess stroke severity and identify patients with acute stroke and large artery occlusion in a prehospital setting. Lucas County EMS staff received a four hour block of continuing education with credit on acute stroke, the updated protocol and algorithm, and use of the new RACE scale in addition to the CPPS. Effectiveness of the training and use of the RACE alert was measured by the percent of patients accurately identified with and without large artery occlusion. Results: Training was provided to 450 EMS staff in several in-person sessions in June 2015. The RACE protocol went citywide on July first. Of the 18 patients brought in to our hospital by EMS in July using the RACE protocol, 72% were identified correctly using the tool. Of these, 6 were identified correctly as having large vessel occlusions and 7 were correctly identified as not having large vessel occlusions. The remaining 5 patients transported by EMS were identified as large vessel occlusions, but were not found to have strokes (seizures, intoxication, and conversion disorders). Conclusion: Our data suggests that first responders can accurately differentiate between which stroke patients could benefit from endovascular treatment using a simple algorithm. Future evaluation could measure the relationship between accurate pre-hospital identification and treatment rates.

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