Abstract WP244: How Many Potential Mechanical Thrombectomy Patients Are Missed Because of Emergency Medical Systems Transport Windows of 4.5 Hours or Less Since Last Known Normal in the Field?

Intro: Many EMS transport protocols exclude patients last known normal (LKN) >4.5 or >6 hours from transport to Comprehensive Stroke Center (CSC) as acute stroke codes. Because recent Mechanical Thrombectomy (MET) studies enrolled few patients last known normal (LKN) > 6 hours prior to imaging, the incidence of CTP or ASPECTS suggesting possible benefit from MET in this time window for Large Vessel Occlusion (LVO) ischemic stroke is unclear. Method: Through retrospective review of a prospective database, the percentage of LVO patients with ASPECTS or CTP suggesting possible benefit from MET, defined as ASPECTS score >5 or salvageable penumbra and <70ml ischemic core on CTP, was compared between a group of 42 patients imaged > 6 hours since LKN and 106 patients imaged <6 hours since LKN. Results: 33% (14 of 42) of LVO patients LKN > 6 hours at time of CTP imaging (median 8 hours, range 6-20 hrs) received MET based on favorable CTP imaging and disabling clinical deficits. This was not statistically significantly different than the 40.5% (43 of 106) of LVO patients LKN < 6 hours at time of CTP imaging (median 128 min) that received MET based on same criteria (OR 95% CI, 0.73 0.34 – 1.55; P=0.42). The LKN > 6 hour MET patients (median NIHSS 18) had a trend towards less frequent favorable home or rehab discharge destination than the LKN < 6 hour MET patients (median NIHSS 16) (29% vs 57%, OR 0.3040, 95 % CI: 0.08 to 1.12, P = 0.07). There were no significant differences between the > 6 hour and <6 hour groups in factors associated with poor outcome after intervention or poor collateral circulation: median ASPECTS score (9 for both), percentage of ASPECTS scores >5 (80% vs 90%, p=0.31) median age (74 for both), ED glucose >150 mg/dl (16.6% vs 23.5%, p= 0.51), Atrial fibrillation (38% vs 37%). With a 30 minute door-to-CTP time, a < 4.5 hour LKN EMS transport policy would have excluded 24.5% of patients who received MET at our CSC. 6, 8, 10 and 13 hour LKN EMS transport windows would have excluded 11%, 9%, 2% and 0% MET intervention patients respectively. Conclusion: < 4.5 hour LKN EMS transport protocols may exclude a significant number of LVO patients with CTP and ASPECTS results possibly suitable for MET. These data need to be confirmed with a prospective multicenter study.

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Abstract 1122‐000091: Predictors of Symptomatic Hemorrhagic Transformation After Mechanical Thrombectomy in Acute Ischemic Stroke

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000091 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Anqi Luo ◽

Agnelio Cardenas ◽

Lee A Birnbaum

Keyword(s):

Risk Factors ◽

Mechanical Thrombectomy ◽

Standard Of Care ◽

Hemorrhagic Transformation ◽

Current Standard ◽

Vessel Occlusion ◽

Increased Risk ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Iv Tpa

Introduction : Mechanical thrombectomy (MT) has become the current standard of care for large vessel occlusion stroke but is associated with an increased risk of intracranial hemorrhage (ICH). Although several studies have investigated the risk factors, there is still limited, not well‐established data. This study aims to evaluate the risk factors of HT after MT. Methods : We retrospectively reviewed all MT patients who were treated at a single comprehensive stroke center from 12/2016 to 7/2019. Variables included initial NIHSS, blood glucose, initial systolic blood pressure, age, gender, IV tPA, time from door to recanalization, and TICI score. Outcome measures were HT on post‐procedure or 24‐hour post‐tPA head CT/MRI as well as modified Rankin scale (mRS) upon discharge. Results : Among 74 patients (68.8 ± 14 years, men 47.3%), 9 (12.2%) experienced hemorrhagic transformation after thrombectomy. Average admitting NIHSS was significantly higher in the HT group (22 vs 16.8, p = 0.041). TICI 3 after MT was protective for HT (OR 0.078, 95% CI 0.009‐0.663). IV tPA (OR 3.86, 95% CI 1.448‐10.326) was associated with good neurological outcome at discharge (mRS < = 2), but HT was not (OR 0.114, 95% CI 0.013‐0.964). Patients with mRS < = 2 upon discharge were younger (65.2±12 vs 71.9±15, p = 0.04) and had lower initial BG (124±45.8 vs 157±69.6, P = 0.02). Conclusions : TICI 3 score, decreased NIHSS, and lower BG were associated with less HT and better outcomes in our MT cohort. Admitting NIHSS > = 20 may be a reasonable threshold to predict HT after MT. Our findings are consistent with the TICI‐ASPECTS‐glucose (TAG) score to predict sICH; however, we used initial NIHSS as a surrogate for ASPECTS. Further studies may utilize additional quantitative measures such as CTP data to predict HT.

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Abstract P562: The Safety Of Mechanical Thrombectomy In Nonagenarians In A Majority Hispanic Population

Stroke ◽

10.1161/str.52.suppl_1.p562 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Nura Salhadar ◽

WONDWOSSEN TEKLE ◽

Amrou Sarraj ◽

Ameer E Hassan

Keyword(s):

Primary Outcome ◽

Mechanical Thrombectomy ◽

Statistical Significance ◽

Hispanic Population ◽

Vessel Occlusion ◽

Border Communities ◽

Baseline Characteristics ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

The Impact

Background and objective: Elderly patients were underrepresented in RCTs that proved the efficacy and safety of mechanical thrombectomy (MT) in acute ischemic strokes (AIS) due to large vessel occlusion (LVO). Additionally, the impact of race and socio-economics in AIS outcomes is well-reported. We sought to assess MT clinical outcomes in Hispanic Octogenarians and Nonagenarians that reside in underserved border communities. Methods: A retrospective cohort study from a prospectively collected comprehensive stroke center database was conducted. The primary outcome was discharge (mRS 0-2). Secondary outcomes were NIHSS improvement ≥4 points at discharge, sICH, mortality and length of stay (LOS). A two-tailed t-test assessed statistical significance between the two groups. Results: Of 202 included patients, 172 (85%) were octogenarians and 30 nonagenarians (17%). Nonagenarians had higher rates of females (80% vs 59%; p<0.05), similar rates of Hispanics (57% vs. 63%, p-xx) and a trend towards higher NIHS (20 vs. 17, P=0.09). Other baseline characteristics were similar (Table 1). Time last known well to arrival to MT center and to recanalization were longer in octogenarians, all other time metrics did not differ. Nonagenarians had numerically lower favorable outcomes at discharge (7% vs. 16%, p=0.11) as compared to octogenarians. Rates of clinical improvement on NIHSS were similar (27% vs. 23%, p=0.74). Mortality (23% vs. 28%, p=0.63) and sICH (7% vs 4%, p=0.46), octogenarians and nonagenarians, respectively. Octogenarians trended towards longer LOS (10 vs 6 days, p=0.05). Conclusions: Both groups had lower favorable good outcome rates than MT outcomes reported in RCTs. Nonagenarians had numerically lower favorable outcomes but mortality and sICH were similar. Further studies are warranted to further assess the impact of age and socioeconomics on MT outcomes.

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Thrombectomy 6-24 hours after stroke in trial ineligible patients

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-013915 ◽

2018 ◽

Vol 10 (11) ◽

pp. 1033-1037 ◽

Cited By ~ 28

Author(s):

Shashvat M Desai ◽

Marcelo Rocha ◽

Bradley J Molyneaux ◽

Matthew Starr ◽

Cynthia L Kenmuir ◽

...

Keyword(s):

Time Window ◽

Functional Independence ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Off Label ◽

Symptomatic Intracranial Hemorrhage ◽

Comprehensive Stroke Center ◽

Stroke Center

Background and purposeThe DAWN and DEFUSE-3 trials demonstrated the benefit of endovascular thrombectomy (ET) in late-presenting acute ischemic strokes due to anterior circulation large vessel occlusion (ACLVO). Strict criteria were employed for patient selection. We sought to evaluate the characteristics and outcomes of patients treated outside these trials.MethodsA retrospective review of acute ischemic stroke admissions to a single comprehensive stroke center was performed during the DAWN trial enrollment period (November 2014 to February 2017) to identify all patients presenting in the 6–24 hour time window. These patients were further investigated for trial eligibility, baseline characteristics, treatment, and outcomes.ResultsApproximately 70% (n=142) of the 204 patients presenting 6–24 hours after last known well with NIH Stroke Scale score ≥6 and harboring an ACLVO are DAWN and/or DEFUSE-3 ineligible, most commonly due to large infarct burden (38%). 26% (n=37) of trial ineligible patients with large vessel occlusion strokes received off-label ET and 30% of them achieved functional independence (modified Rankin Scale 0–2) at 90 days. Rates of symptomatic intracranial hemorrhage and mortality were 8% and 24%, respectivelyConclusionTrial ineligible patients with large vessel occlusion strokes receiving off-label ET achieved outcomes comparable to DAWN and DEFUSE-3 eligible patients. Patients aged <80 years are most likely to benefit from ET in this subgroup. These data indicate a larger population of patients who can potentially benefit from ET in the expanded time window if more permissive criteria are applied.

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Eligibility for late endovascular treatment using DAWN, DEFUSE-3, and more liberal selection criteria in a stroke center

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015382 ◽

2019 ◽

Vol 12 (9) ◽

pp. 842-847 ◽

Cited By ~ 4

Author(s):

Stefania Nannoni ◽

Davide Strambo ◽

Gaia Sirimarco ◽

Michael Amiguet ◽

Peter Vanacker ◽

...

Keyword(s):

Endovascular Treatment ◽

Selection Criteria ◽

Time Window ◽

Real Life ◽

Good Health ◽

Late Time ◽

Vessel Occlusion ◽

Stroke Registry ◽

Comprehensive Stroke Center ◽

Stroke Center

Background and purposeThe real-life application of DAWN and DEFUSE-3 trials has been poorly investigated. We aimed to identify the proportion of patients with acute ischemic stroke (AIS) eligible for late endovascular treatment (EVT) in our stroke center based on trial and more liberal selection criteria.MethodsAll consecutive patients in our stroke registry (2003–2017) admitted within 5–23 hours of last proof of good health were selected if they had complete clinical and radiological datasets. We calculated the proportion of patients eligible for late EVT according to trial (DAWN and/or DEFUSE-3) and more liberal clinical/imaging mismatch criteria (including lower admission National Institutes of Health Stroke Scale score and Alberta Stroke Program Early CT Score for core estimation).ResultsOf 1705 patients with AIS admitted to our comprehensive stroke center in the late time window, we identified 925 patients with complete clinical and radiological data. Among them, the proportions of late EVT eligibility were 2.5% (n=23) with DAWN, 5.1% (n=47) with DEFUSE-3, and 11.1% (n=103) with more liberal criteria. Considering late-arriving patients with large vessel occlusion (n=221), the percentages of eligible patients were 10.4%, 21.3%, and 46.6%, respectively. A favorable outcome was observed at comparable rates in treated patients selected by trial or liberal criteria (67% vs 58%, p=0.49).ConclusionsIn a long-term stroke registry, the proportion of late EVT eligibility varied greatly according to selection criteria and referral pattern. Among late-arriving patients referred to our comprehensive stroke center, we found 5.6% eligible according to trial (DAWN/DEFUSE-3) and 11.1% according to liberal criteria. These data indicate that late EVT could be offered to a larger population of patients if more liberal criteria are applied.

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Abstract 1122‐000179: Very Low Rates of Intracerebral Hemorrhage in Patients Transferred for Mechanical Thrombectomy

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000179 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Yazan Radaideh

Keyword(s):

Intracerebral Hemorrhage ◽

Mechanical Thrombectomy ◽

Intravenous Thrombolysis ◽

Vessel Occlusion ◽

Single Center Experience ◽

True Value ◽

Intravenous Alteplase ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Repeat Imaging

Introduction : Background: A common convention among stroke patients being transferred for mechanical thrombectomy, particularly if intravenous thrombolysis has been given, is to undergo a repeat plain brain CT at the treating stroke center. The most concerning among several concerns is the discovery of intracerebral hemorrhage (ICH) which would obviate the value of thrombectomy. This practice has been shown in a previous series to result in a median treatment delay of 20 minutes[1]. By determining the actual incidence of any ICH seen on neuroimaging in patients who undergo repeat imaging on arrival to comprehensive stroke center prior to intervention, we can better determine the true value of this convention of repeat imaging. Methods : Retrospective review of all patients transferred to a single academic comprehensive stroke center for mechanical thrombectomy. We evaluated for the frequency of repeat imaging, the rate of ICH and the rate of undergoing mechanical thrombectomy. Results : There were 682 patients transferred directly for mechanical thrombectomy evaluation over the study period. Intravenous Alteplase was administered to 391 patients prior to arrival and 2 had it on arrival to destination hospital. Plain head CT was repeated at the hub hospital in 590/682 patients (86.5%) (348 with thrombolytics and 242 without. A new intracerebral hemorrhage (ICH) was detected in 9 patients. In only 3 of the 9 patients was mechanical thrombectomy deferred solely due to the ICH (other 6 had no evidence of LVO (4), low ASPECTS (1) or exam improvement (1)). Conclusions : In patients being transferred for mechanical thrombectomy, the rate of ICH on arrival to site hospital was 1.5%. In only one third of those patients (0.5%) was the decision to not proceed with mechanical thrombectomy related to the new ICH. Given the delays in door to puncture times associated with repeat imaging indicated in literature and the low yield in detecting ICH in transfer patients, repeating neuroimaging at comprehensive stroke center obtained for the purpose of ruling out ICH on patients transferred for MT should be reconsidered. Limitations: Our study reflects a single center experience. Other indications for repeat imaging at comprehensive stroke center such as assessment of infarcted core, and presence of large vessel occlusion might still warrant repeat imaging at comprehensive stroke center.

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Abstract WMP89: Outcomes No Different in Real World Including Direct vs Drip-and-Ship Patients: Power of Reperfusion From Mechanical Thrombectomy

Stroke ◽

10.1161/str.51.suppl_1.wmp89 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Darshan G Shah ◽

Aravi Loganathan ◽

Dan Truong ◽

Fiona Chan ◽

Bruce Campbell ◽

...

Keyword(s):

Functional Outcome ◽

Real World ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Vessel Occlusion ◽

Excellent Functional Outcome ◽

The Mean ◽

Comprehensive Stroke Center ◽

Stroke Center

Background: Mechanical thrombectomy (MT) became standard care in 2015 after positive trials in patients presenting with acute ischemic stroke and large vessel occlusion (LVO) 0-6h and in 2018 for selected patients up to 24h from symptom onset. Objective: To evaluate whether patients receiving MT at our center would have comparable outcomes in patients presenting to our comprehensive stroke center (direct) vs transfer patients (drip-and-ship) Methods: This is a retrospective observational study utilising prospectively collected stroke database for patients receiving MT for LVO in anterior and posterior circulation in South Brisbane network of 7 hospitals (6 drip-and-ship centers and 1 MT-capable center), Australia which serves 1.6 million. Day 90 modified Rankin scale (mRS) was used to assess functional outcomes via outpatient follow up at direct or referral center. The association of drip and ship versus mothership treatment with day 90 mRS was tested in ordinal logistic regression adjusted for age, baseline NIHSS and IV thrombolysis. Results: Of 191 patients who underwent Mechanical Thrombectomy from 2015 to June 2018 at our center, 22 patients were excluded from analysis as either their baseline mRS was >1 (13) or follow up data was missing (9). The mean age was 64.4 years. Median (inter-quartile range, IQR) NIHSS was 16 (9-21) on admission and 7 (2-18) on day 1. Thrombolysis in Cerebral Infarction (TICI) ≥2b was achieved in 88.9%. At 90 days, 50.9% achieved excellent functional outcome (mRS 0-1), 61.4% achieved good functional outcome (mRS 0-2) and 69% achieved favorable outcome (mRS 0-3). Median mRS was 1 (IQR 0-5) in 96 patients presenting directly to the endovascular center and 1 (IQR 1-4) in 73 drip-and-ship patients (common odds ratio 1.07 (95%CI 0.62-1.83), p=0.82) Conclusion: Our 7-center network experience confirms real world reproducibility of trial results, interestingly with no difference in functional outcomes for direct vs drip-and-ship patients.

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Increased incidence and treatment of intracranial atherosclerotic disease during mechanical thrombectomy is safe, even with an increased number of passes

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-017114 ◽

2021 ◽

pp. neurintsurg-2020-017114

Author(s):

Marlon Carl Monayao ◽

Ahmed A Malik ◽

Laurie Preston ◽

Marlon Carl Monayao Sr ◽

Wondwossen Tekle ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Atherosclerotic Disease ◽

Vessel Occlusion ◽

Intracranial Atherosclerotic Disease ◽

Significant Difference ◽

Artery Disease ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Angioplasty And Stenting ◽

Number Of Passes

BackgroundThe incidence of intracranial atherosclerotic disease (ICAD) in acute ischemic stroke treated with mechanical thrombectomy (MT) is not well defined, and its description may lead to improved stroke devices and rates of first pass success.MethodsA retrospective study was performed on MT patients from 2012 to 2019 at a comprehensive stroke center using chart review and angiogram analysis. Angiograms at the time of MT were reviewed for ICAD, and location and severity were recorded. Patients with ICAD were divided according to ICAD location relative to the large vessel occlusion (LVO) site. Statistical analyses were performed on baseline demographics, comorbidities, MT procedure variables, outcome variables, and their association with ICAD.ResultsOf the 533 patients (mean age 70.4 (SD 13.20) years, 43.5% women), 131 (24.6%) had ICAD. There was no significant difference in favorable discharge outcomes (modified Rankin Scale score of 0–2; 23.8% ICAD vs 27.0% non-ICAD; p=0.82) or groin puncture to recanalization times (average 43.5 (range 8–181) min for ICAD vs 40.2 (4–204) min for non-ICAD; p=0.42). Patients with ICAD experienced a significantly higher number of passes (average 1.8 (range 1–7) passes for ICAD vs 1.6 (1–5) passes for non-ICAD; p=0.0059). Adjusting for age, ≥3 device passes, baseline National Institutes of Health Stroke Scale, rates of angioplasty only, rates of concurrent angioplasty and stenting, coronary artery disease and atrial fibrillation incidences, and time from emergency department arrival to recanalization, yielded no significant difference in rates of favorable outcomes between the two groups.ConclusionPatients who underwent MT with underlying ICAD had similar rates of favorable outcomes as those without, but required a higher number of device passes.

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Team Prenotification Reduces Procedure Times for Patients With Acute Ischemic Stroke Due to Large Vessel Occlusion Who Are Transferred for Endovascular Therapy

Frontiers in Neurology ◽

10.3389/fneur.2021.787161 ◽

2022 ◽

Vol 12 ◽

Author(s):

Lars-Peder Pallesen ◽

Simon Winzer ◽

Christian Hartmann ◽

Matthias Kuhn ◽

Johannes C. Gerber ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Endovascular Therapy ◽

Vessel Occlusion ◽

Team Members ◽

Interventional Neuroradiologist ◽

Patient Arrival ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Prospective Database

Background: The clinical benefit from endovascular therapy (EVT) for patients with acute ischemic stroke is time-dependent. We tested the hypothesis that team prenotification results in faster procedure times prior to initiation of EVT.Methods: We analyzed data from our prospective database (01/2016–02/2018) including all patients with acute ischemic stroke who were evaluated for EVT at our comprehensive stroke center. We established a standardized algorithm (EVT-Call) in 06/2017 to prenotify team members (interventional neuroradiologist, neurologist, anesthesiologist, CT and angiography technicians) about patient transfer from remote hospitals for evaluation of EVT, and team members were present in the emergency department at the expected patient arrival time. We calculated door-to-image, image-to-groin and door-to-groin times for patients who were transferred to our center for evaluation of EVT, and analyzed changes before (–EVT-Call) and after (+EVT-Call) implementation of the EVT-Call.Results: Among 494 patients in our database, 328 patients were transferred from remote hospitals for evaluation of EVT (208 -EVT-Call and 120 +EVT-Call, median [IQR] age 75 years [65–81], NIHSS score 17 [12–22], 49.1% female). Of these, 177 patients (54%) underwent EVT after repeated imaging at our center (111/208 [53%) -EVT-Call, 66/120 [55%] +EVT-Call). Median (IQR) door-to-image time (18 min [14–22] vs. 10 min [7–13]; p < 0.001), image-to-groin time (54 min [43.5–69.25] vs. 47 min [38.3–58.75]; p = 0.042) and door-to-groin time (74 min [58–86.5] vs. 60 min [49.3–71]; p < 0.001) were reduced after implementation of the EVT-Call.Conclusions: Team prenotification results in faster patient assessment and initiation of EVT in patients with acute ischemic stroke. Its impact on functional outcome needs to be determined.

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Abstract TP49: Acute Intracranial Stenting With Mechanical Thrombectomy Shows No Difference in Discharge Outcomes Compared With Mechanical Thrombectomy Alone

Stroke ◽

10.1161/str.51.suppl_1.tp49 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Ameer E Hassan ◽

Victor M Ringheanu ◽

Wondwossen G Tekle ◽

Laurie Preston ◽

Adnan I Qureshi

Keyword(s):

Length Of Stay ◽

Mechanical Thrombectomy ◽

Vessel Occlusion ◽

Intracranial Stenting ◽

Symptomatic Intracerebral Hemorrhage ◽

Discharge Outcomes ◽

Poor Outcomes ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Proven Method

Background: Mechanical thrombectomy (MT) is a proven method of treating patients with acute ischemic stroke (AIS) from a large vessel occlusion. However, there has been controversy regarding the safety and efficacy of incorporating acute intracranial stenting in addition to standard MT especially after the WEAVE trial results which showed a significant increase in stroke and hemorrhage in patients receiving wingspan stenting within 7 days of index ischemic event. We compared the outcomes of all AIS patients treated with acute intracranial stenting + MT versus MT alone. Methods: Through the utilization of a prospectively collected endovascular database at a comprehensive stroke center between 2012-2019, variables such as demographics, co-morbid conditions, symptomatic intracerebral hemorrhage (ICH), mortality rate at discharge, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score (TICI) and modified Rankin Scale at discharge (mRS dc) were examined. The outcomes between patients receiving acute intracranial stenting + MT and patients that underwent MT alone were compared. Results: There were a total of 439 AIS patients who met criteria for the study (average age 70.38 ± 13.46 years; 45.6% were women). Analysis of 36 patients from the acute stenting + MT group (average age 66.72 ± 13.17 years; 30.6% were women), and 403 patients from the MT Alone group (average age 70.71 ± 13.45 years; 46.9% were women); see Table 1 for baseline characteristics and outcomes. Three patients (8.3%) in the acute stenting + MT group experienced ICH versus forty-four patients (10.9%) in the MT alone group (P=0.631); no significant increases were noted in length of stay (9.08 days vs 9.84 days; P=0.620) or good mRS scores at dc (P=0.636). Conclusion: Acute intracranial stenting in addition to MT was not associated with an increase in ICH rates, overall length of stay, or poor outcome upon discharge of patients. Prospective studies are recommended.

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Abstract P501: Safety and Efficacy of Repeat Mechanical Thrombectomy After Early and Delayed Reocclusion- A Case Series From Two Comprehensive Stroke Center and Meta-Analysis

Stroke ◽

10.1161/str.52.suppl_1.p501 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Nurose Karim ◽

Harsh Desai ◽

Nicholas Henkel ◽

Alicia Castonguay ◽

Syed F Zaidi

Keyword(s):

Mechanical Thrombectomy ◽

Recurrent Stroke ◽

Meta Analysis ◽

Anticoagulation Therapy ◽

Case Series ◽

Median Number ◽

Vessel Occlusion ◽

Safety And Efficacy ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction: Limited data exist about the safety and efficacy of repeat mechanical thrombectomy (MT) in patients with recurrent large vessel occlusion (rLVO). Here, we present a case series examining the outcome of early and delayed rLVO and the safety of repeat MT. Methods: We reviewed our prospectively-collected endovascular database for acute ischemic stroke (AIS) patients with LVO who underwent MT between July 2012 and February 2020. We included patients with recurrent stroke requiring repeat MT after successful first MT, either in the same vessel or in a different vascular territory, within 24 hours up to 924 days and compared it with patients who underwent single MT. Baseline demographics, angiographic, procedural, and outcomes data were compared in AIS patients who underwent recurrent MT (RT) versus single MT (ST). We completed a meta-analysis that evaluated papers from 2015 to 2020 which examined reocclusion after MT. Result: A total of 738 MT patients were included, of which 726 (98.4%) were in the ST group and 12 (1.6%) in the RT group (Table 1). Baseline characteristics were well balanced between the cohorts. The most common site of occlusion was in the MCA territory. Last known well (559 ± 982 vs. 267 ± 301 minutes, p = 0.358) was similar between the groups. There was no difference in the median number of passes (2 IQR 1-3, p=0.61) in the ST and RT groups, respectively. In the RT group, the mean time between repeat occlusion was 132.5 ± 275 days. Revascularization success, sICH rates (25% vs. 7.1%, p= 0.306), and mean 90-day mRS (1.3 ± 2.3 vs. 1.8 ± 2.7, p = 0.63) did not differ between the first MT (FT) and RT cohorts. No association between reocclusion and MT device (aspiration or stent-retriever), tPA given, statin, antiplatelet or anticoagulation therapy was found in the meta-analysis. Conclusion: Repeat MT in patients with early or delayed reocclusion appears to be safe. Larger, prospective studies are needed to evaluate these findings.

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