Abstract TP48: IV tPA is Associated With Increase in Intracerebral Hemorrhage Rates and Length of Stay in Acute Stroke Patients Treated With Endovascular Treatment Within 4.5 Hours; Should We Bypass IV tPA in Large Vessel Occlusion?

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Victor M Ringheanu ◽  
Laurie Preston ◽  
Rani Rabah ◽  
Amrou Sarraj ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Endovascular Treatment ◽  
Large Vessel ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Poor Outcomes ◽  
Comprehensive Stroke Center ◽  
Iv Tpa

Background: Endovascular treatment (EVT) is a widely proven method to treat patients diagnosed with intracranial large vessel occlusions (LVO); however, there has been controversy regarding the safety and efficacy of incorporating intravenous tissue plasminogen activator (IV tPA) as pretreatment for EVT. We compared the outcomes of all LVO patients treated with IV tPA + EVT versus EVT alone within 4.5 hours of stroke onset. 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/asymptomatic intracerebral hemorrhage (S-ICH/A-ICH), mortality rate, and good/poor outcomes in regard to modified thrombolysis in cerebral infarction score (TICI) and modified Rankin Scale assessment at discharge (mRS dc) were examined. The outcomes between patients receiving IV tPA + EVT upon admission and patients that underwent EVT alone were compared. Results: Out of 588 acute ischemic stroke patients treated with EVT, a total of 189 met the criteria for the study (average age 70.44 ± 12.90 years, 42.86% women). Analysis of 109 patients from the EVT + IV tPA (average age 68.17 ± 14.28 years, 41.28% women), and 80 patients from the EVT alone was performed (average age 73.54 ± 9.84 years, 45.00% women); see Table 1 for baseline characteristics and outcomes. Four patients (5.0%) in the EVT alone group experienced S-ICH versus 15 patients (13.8%) in the IV tPA + EVT group (p=.0478); significant increases were also noted in the length of stay for patients treated with IV tPA (8.2 days vs 11.0 days; P=.0055). Conclusion: IV tPA in addition to EVT was associated with an increase in the rate of ICH in LVO patients treated within 4.5 hours and in patients’ length of stay. Further research is required to determine whether EVT treatment alone in LVO patients treated within 4.5 hours is a more effective option.

IV tPA is associated with increase in rates of intracerebral hemorrhage and length of stay in patients with acute stroke treated with endovascular treatment within 4.5 hours: should we bypass IV tPA in large vessel occlusion?

2020 ◽  
pp. neurintsurg-2020-016045 ◽  
Author(s):  
Ameer E Hassan ◽  
Victor M Ringheanu ◽  
Laurie Preston ◽  
Wondwossen Tekle ◽  
Adnan I Qureshi
Keyword(s):  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Endovascular Treatment ◽  
Large Vessel ◽  
Vessel Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Poor Outcomes ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Iv Tpa

BackgroundEndovascular treatment (EVT) is a widely proved method to treat patients diagnosed with intracranial large vessel occlusions (LVOs); however, there has been controversy about the safety and efficacy of incorporating intravenous tissue plasminogen activator (IV tPA) as pretreatment for EVT.ObjectiveTo compare the outcomes of all patients with LVO treated with IV tPA +EVT versus EVT alone within 4.5 hours of stroke onset.MethodsA prospectively collected endovascular database at a comprehensive stroke center between 2012 and 2019 was used to examine variables such as demographics, comorbid conditions, symptomatic/asymptomatic intracerebral hemorrhage (ICH), mortality rate, and good/poor outcomes as shown by the modified Thrombolysis in Cerebral Infarction score and modified Rankin Scale (mRS) assessment at discharge. The outcomes between patients receiving IV tPA+EVT on admission and patients who underwent EVT alone were compared.ResultsOf 588 patients with acute ischemic stroke treated with EVT, a total of 189 met the criteria for the study (average age 70.44±12.90 years, 42.9% women). Analysis of 109 patients from the group receiving EVT+IV tPA (average age 68.17±14.28 years, 41.3% women), and 80 patients from the EVT alone group was performed (average age 73.54±9.84 years, 45.0% women). Four patients (5.0%) in the EVT alone group experienced symptomatic ICH versus 15 patients (13.8%) in the IV tPA+EVT group (p=0.0478); significant increases were also noted in the length of stay for patients treated with IV tPA (8.2 days vs 11.0 days; p=0.0056).ConclusionIV tPA in addition to EVT was associated with an increase in the rate of ICH in patients with LVO treated within 4.5 hours and in patients’ length of stay. Further research is required to determine whether EVT treatment alone in patients with LVO treated within 4.5 hours is a more effective option.

Abstract WMP12: Does IV tPA Improve Outcomes in Stroke Patients with Large Vessel Occlusions Treated with Intra-arterial Therapy?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joseph T Ho ◽  
Jason W Tarpley ◽  
Hsin-Fang Li
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Time Frame ◽  
Large Vessel ◽  
Categorical Variables ◽  
Complication Rates ◽  
Continuous Variables ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Iv Tpa

Introduction: The benefit of endovascular therapy (IAT) for the treatment of emergent large vessel occlusion (ELVO) in stroke patients has been established. However, it is not known whether administration of IV tPA prior to IAT is beneficial in these patients. Methods: A retrospective review of ischemic stroke patients in the Providence Health & Services Get with the Guidelines (GWTG) database was performed from 01/2012 to 05/2016. The analysis was limited to patients who presented within 4.5 hours of last known well time (LKWT) and treatment included any form of IAT. End points were limited to data available in the GWTG database, including discharge mRS, discharge NIHSS, change in NIHSS from admission to discharge, and length of stay. Continuous variables were summarized using means and standard deviation while categorical variables were summarized using frequencies and percentages. To yield a more robust estimate against outliers for the time-related variables, medians and interquartile range (IQR) were computed and assessed using Wilcoxon rank sum tests. Chi-square tests and independent two-sample t-tests were used to evaluate the demographic and outcome differences for categorical and continuous variables, respectively. Results: A total of 10,868 patients with an ischemic stroke diagnosis were found in the specified time frame and presented within 4.5 hours of LKWT. Of these, 461 patients were treated with some form of IAT, 235 received IV tPA prior to IAT, 226 had IAT alone due to contraindication to IV tPA. There was no statistical difference in patient demographics, complication rates, TICI score, discharge NIHSS or mRS at discharge. There was a significantly higher NIHSS on admission (18.3 vs 16.7, p = 0.026), greater improvement in NIHSS (11.6 vs. 7.9, p=0.012), longer door to IAT (146 vs 101.5 min, p < 0.0001), and shorter length of stay (5 vs 6 days, p = 0.016) in the IV tPA group. Conclusions: These data suggest that IV tPA, when administered to eligible patients with ELVO, provided some benefit over IAT alone, even though it delayed IAT. Future prospective randomized trials are planned that may better address this question, but these results underscore the need for retrospective analysis of existing data.

Abstract TP292: Telestroke vs Phone Consultation in Stroke Patients Eligible for Intra-Arterial Therapy

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Nicholas Osteraas ◽  
James Conners ◽  
Shawna Cutting ◽  
Sarah Song ◽  
Laurel Cherian ◽  
...  
Keyword(s):  
Female Gender ◽  
Large Vessel ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Telephone Consultation ◽  
Transfer Programs ◽  
Intravenous Tissue Plasminogen Activator ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
Mean Time

Background and Objective: Intra-arterial therapy (IA) is beneficial for acute ischemic stroke patients with large vessel occlusions who have received intravenous tissue plasminogen activator (IVtPA). Telestroke has not been associated with increased IVtPA utilization rates when compared to phone consultations. We sought to determine whether telestroke improved the process of evaluation and transfer of patients who may be eligible for intra-arterial therapy (IA). Methods: The Rush telestroke program consists of an academic hub (comprehensive stroke center) that serves 10 spoke emergency departments (EDs). For sites outside of the telestroke program, the patient receives telephone consultation from the same pool of telestroke neurologists. IA therapy is considered for patients clinically suspected of having a large vessel occlusion who could potentially be treated with IA within 6 hours of last known normal (LKN). We compared IA eligible stroke patients transferred via the telestroke program to those non-telestroke transfer patients. Results: From July 1, 2013 to July 1, 2015, 126 patients were transferred from outside hospital ERs to our institution for potential IA; 6 patients were excluded for non-stroke diagnosis. Among 119 patients, 79 (66%) were evaluated via telestroke and 40 (34%) via phone consultation. There was no difference between groups for age (63.3 vs 59.3 years, p=0.14) female gender (52% vs 58%, p=0.70), hypertension (66% vs 78%, p 0.21), atrial fibrillation (27% vs 20%, p=0.50), initial arrival NIHSS (17 vs 19, p=0.12), frequency of IA (66% vs 55%, p=0.31), mean time from LKN to IVtPA administration (139 vs 138 minutes, p=0.96), mean time from IVtPA administration to arrival (106 vs 94 minutes, p=0.31), and mean time from arrival to IA start (35 vs 31 minutes, p=0.44). More patients who were evaluated via telestroke received TPA compared to those evaluated via phone (80% vs 63%, p<0.05). Conclusions: Telestroke improves the evaluation of IA eligible stroke transfer patients by increasing the rates of IVtPA compared with telephone consultation alone. Comprehensive stroke centers may benefit patients by incorporating telestroke systems into their IA transfer programs.

Effect of “drip-and-ship” and “drip-and-drive” on endovascular treatment of acute ischemic stroke with large vessel occlusion: a single-center retrospective study

2021 ◽  
pp. 028418512110068
Author(s):  
Yu Hang ◽  
Zhen Yu Jia ◽  
Lin Bo Zhao ◽  
Yue Zhou Cao ◽  
Huang Huang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Primary Stroke Center ◽  
Secondary Endpoints ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background Patients with acute ischemic stroke (AIS) caused by large vessel occlusion (LVO) were usually transferred from a primary stroke center (PSC) to a comprehensive stroke center (CSC) for endovascular treatment (drip-and-ship [DS]), while driving the doctor from a CSC to a PSC to perform a procedure is an alternative strategy (drip-and-drive [DD]). Purpose To compare the efficacy and prognosis of the two strategies. Material and Methods From February 2017 to June 2019, 62 patients with LVO received endovascular treatment via the DS and DD models and were retrospectively analyzed from the stroke alliance based on our CSC. Primary endpoint was door-to-reperfusion (DTR) time. Secondary endpoints included puncture-to-recanalization (PTR) time, modified Thrombolysis in Cerebral Infarction (mTICI) rates at the end of the procedure, and modified Rankin Scale (mRS) at 90 days. Results Forty-one patients received the DS strategy and 21 patients received the DD strategy. The DTR time was significantly longer in the DS group compared to the DD group (315.5 ± 83.8 min vs. 248.6 ± 80.0 min; P < 0.05), and PTR time was shorter (77.2 ± 35.9 min vs. 113.7 ± 69.7 min; P = 0.033) compared with the DD group. Successful recanalization (mTICI 2b/3) was achieved in 89% (36/41) of patients in the DS group and 86% (18/21) in the DD group ( P = 1.000). Favorable functional outcomes (mRS 0–2) were observed in 49% (20/41) of patients in the DS group and 71% (15/21) in the DD group at 90 days ( P = 0.089). Conclusion Compared with the DS strategy, the DD strategy showed more effective and a trend of better clinical outcomes for AIS patients with LVO.

Abstract TP129: Factor VIII in Acute Cerebral Ischemia Trial - Biomarker in Patients with Large Vessel Occlusion?

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Digvijaya D Navalkele ◽  
Amelia Boehme ◽  
Karen Albright ◽  
Cindy Leissinger ◽  
Ramy El Khoury ◽  
...  
Keyword(s):  
Factor Viii ◽  
Surrogate Marker ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Significant Independent Predictor ◽  
Intravenous Tissue Plasminogen Activator ◽  
Acute Cerebral Ischemia ◽  
Clot Burden ◽  
Iv Tpa

Introduction: Baseline elevated Factor VIII (FVIII) level is a significant independent predictor of stroke occurrence and severity. We conducted a prospective serial laboratory cohort study to assess the correlation of FVIII levels in response to thrombolysis in patients with large vessel occlusion (LVO) and acute ischemic stroke (AIS). Methods: AIS patients with anterior circulation LVO were enrolled within 4.5 hours from last seen normal. Baseline and serial FVIII levels were obtained to determine whether FVIII serves as a surrogate marker of clot burden and if FVIII levels or changes predict (1) recanalization with intravenous tissue plasminogen activator (IV tPA) or (2) symptomatic intracranial hemorrhage (sICH) following tPA. Linear and logistic regression analyses were used to determine significant predictors. Results: Patients (n=29) had a mean age of 71years, median NIHSS of 15, 62% were of black race and 48% were female. Baseline pre -tPA FVIII was not significantly correlated with clot burden score (-0.15, p=0.45) or vessel recanalization (-0.13, p=0.50). Median FVIII decreased significantly from baseline to 6hrs post-tPA (282% to 161%, p=0.0024), but delta in FVIII level did not correlate with vessel recanalization (0.01, p=0.95). No patient had sICH. There was no difference between median FVIII level at baseline and 90 days post AIS. Interpretation: FVIII level decreased significantly after tPA, but baseline FVIII level and early change in FVIII level were not significant predictors of clot burden, vessel recanalization after treatment with IV tPA, or symptomatic hemorrhage. This trial provided no evidence to support the value of acute FVIII level as a biomarker in AIS due to LVO. The physiology behind the decrease in FVIII level after tPA remains unknown.

scholarly journals Prediction of Early Recanalization after Intravenous Thrombolysis in Patients with Large-Vessel Occlusion

2021 ◽  
Vol 23 (2) ◽  
pp. 244-252
Author(s):  
Young Dae Kim ◽  
Hyo Suk Nam ◽  
Joonsang Yoo ◽  
Hyungjong Park ◽  
Sung-Il Sohn ◽  
...  
Keyword(s):  
High Performance ◽  
Validation Cohort ◽  
Intravenous Thrombolysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Derivation Cohort ◽  
Factors Associated ◽  
Intravenous Tissue Plasminogen Activator

Background and Purpose We aimed to develop a model predicting early recanalization after intravenous tissue plasminogen activator (t-PA) treatment in large-vessel occlusion.Methods Using data from two different multicenter prospective cohorts, we determined the factors associated with early recanalization immediately after t-PA in stroke patients with large-vessel occlusion, and developed and validated a prediction model for early recanalization. Clot volume was semiautomatically measured on thin-section computed tomography using software, and the degree of collaterals was determined using the Tan score. Follow-up angiographic studies were performed immediately after t-PA treatment to assess early recanalization.Results Early recanalization, assessed 61.0±44.7 minutes after t-PA bolus, was achieved in 15.5% (15/97) in the derivation cohort and in 10.5% (8/76) in the validation cohort. Clot volume (odds ratio [OR], 0.979; 95% confidence interval [CI], 0.961 to 0.997; <i>P</i>=0.020) and good collaterals (OR, 6.129; 95% CI, 1.592 to 23.594; <i>P</i>=0.008) were significant factors associated with early recanalization. The area under the curve (AUC) of the model including clot volume was 0.819 (95% CI, 0.720 to 0.917) and 0.842 (95% CI, 0.746 to 0.938) in the derivation and validation cohorts, respectively. The AUC improved when good collaterals were added (derivation cohort: AUC, 0.876; 95% CI, 0.802 to 0.950; <i>P</i>=0.164; validation cohort: AUC, 0.949; 95% CI, 0.886 to 1.000; <i>P</i>=0.036). The integrated discrimination improvement also showed significantly improved prediction (0.097; 95% CI, 0.009 to 0.185; <i>P</i>=0.032).Conclusions The model using clot volume and collaterals predicted early recanalization after intravenous t-PA and had a high performance. This model may aid in determining the recanalization treatment strategy in stroke patients with large-vessel occlusion.

Abstract TP248: Reduced Door-in-Door-Out Time Increases the Likelihood of Endovascular Thrombectomy for Large Vessel Occlusion Patients

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Kavit Shah ◽  
Shashvat Desai ◽  
Benjamin Morrow ◽  
Pratit Patel ◽  
Habibullah Ziayee ◽  
...  
Keyword(s):  
Internal Carotid ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy ◽  
Comprehensive Stroke Center ◽  
Stroke Center ◽  
To Receive ◽  
Rapid Transfer

Introduction: Endovascular thrombectomy (EVT) is recommended for patients with large vessel occlusion (LVO) presenting within 24 hours of last seen well (LSW). Unfortunately, patients transferred from spoke hospitals to receive EVT have poorer outcomes compared to those presenting directly to the hub, underscoring the importance of rapid transfer timing - door-in-door-out (DIDO). Methods: Data were analyzed from consecutive acute ischemic stroke patients with proximal large vessel occlusions (LVO) transferred to our comprehensive stroke center for EVT. The following variable were studied: DIDO, baseline NIHSS/mRS, presentation CT ASPECTs, site of LVO, treatment, and clinical outcome. Results: Ninety patients with internal carotid or middle cerebral artery (M1) occlusion at the spoke hospital were included in the study. At the hub hospital, 75% (68) underwent emergent cerebral angiography (DSA) with intent to perform EVT. Reasons for not undergoing angiography at hub hospital included large stroke burden (59%) and improvement in NIHSS score (41%). Overall, DIDO time was 184 (130-285) minutes. Mean DIDO time was significantly lower for patients who underwent DSA at hub hospital compared to patients who did not (207 versus 272 minutes, p=0.031). 92% (12) of patients with DIDO <=120 minutes (n=13) underwent EVT compared to 73% (56) of patients with DIDO >120 minutes (n=77). Every 30-minute delay after 120 minutes lead to a 6% reduction in the likelihood of EVT. Lower DIDO time [OR-0.92 (0.9-0.96), p=0.04] and higher ASPECTS score [OR-1.4 (1.1-1.9), p=0.013] at spoke hospital are predictors of EVT at hub hospital. Conclusion: Reduced DIDO times are associated with higher likelihood of receiving EVT. DIDO should be treated on par as in-hospital time metrics and methods should be in place to optimize transfer times.

scholarly journals Transfer to the Local Stroke Center versus Direct Transfer to Endovascular Center of Acute Stroke Patients with Suspected Large Vessel Occlusion in the Catalan Territory (RACECAT): Study protocol of a cluster randomized within a cohort trial

2019 ◽  
Vol 14 (7) ◽  
pp. 734-744 ◽  
Author(s):  
Sònia Abilleira ◽  
Natalia Pérez de la Ossa ◽  
Xavier Jiménez ◽  
Pere Cardona ◽  
Dolores Cocho ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Acute Stroke ◽  
Arterial Occlusion ◽  
Large Vessel ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Stroke Center ◽  
Cluster Randomized

Rationale Optimal pre-hospital delivery pathways for acute stroke patients suspected to harbor a large vessel occlusion have not been assessed in randomized trials. Aim To establish whether stroke subjects with rapid arterial occlusion evaluation scale based suspicion of large vessel occlusion evaluated by emergency medical services in the field have higher rates of favorable outcome when transferred directly to an endovascular center (endovascular treatment stroke center), as compared to the standard transfer to the closest local stroke center (local-SC). Design Multicenter, superiority, cluster randomized within a cohort trial with blinded endpoint assessment. Procedure Eligible patients must be 18 or older, have acute stroke symptoms and not have an immediate life threatening condition requiring emergent medical intervention. They must be suspected to have intracranial large vessel occlusion based on a pre-hospital rapid arterial occlusion evaluation scale of ≥5, be located in geographical areas where the default health authority assigned referral stroke center is a non-thrombectomy capable hospital, and estimated arrival at a thrombectomy capable stroke hospital in less than 7 h from time last seen well. Cluster randomization is performed according to a pre-established temporal sequence (temporal cluster design) with three strata: day/night, distance to the endovascular treatment stroke center, and week/week-end day. Study outcome The primary endpoint is the modified Rankin Scale score at 90 days. The primary safety outcome is mortality at 90 days. Analysis The primary endpoint based on the modified intention-to-treat population is the distribution of modified Rankin Scale scores at 90 days analyzed under a sequential triangular design. The maximum sample size is 1754 patients, with two planned interim analyses when 701 (40%) and 1227 patients have completed follow-up. Hypothesized common odds ratio is 1.35.

Risk Factors for Distal Clot Migration during Mechanical Thrombectomy of Anterior Circulation Large Vessel Occlusion

2020 ◽  
Vol 49 (2) ◽  
pp. 185-191 ◽  
Author(s):  
Mahmoud H. Mohammaden ◽  
Christopher J. Stapleton ◽  
Denise Brunozzi ◽  
Eman M. Khedr ◽  
Peter Theiss ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Thrombectomy ◽  
Multivariable Analysis ◽  
Large Vessel ◽  
Large Vessel Occlusion ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Multivariable Analyses ◽  
Iv Tpa

Introduction: Distal clot migration (DCM) is a known complication of mechanical thrombectomy (MT), but neither risk factors for DCM nor ways of how it might affect clinical outcomes have been extensively studied to date. Methods: To identify risk factors for and outcomes in the setting of DCM, the records of all patients with acute ischemic stroke due to anterior circulation large vessel occlusion (LVO) treated with MT at a single center between May 2016 and June 2018 were retrospectively reviewed. Uni- and multivariable analyses were performed to evaluate predictors of DCM and good functional outcome (90-day modified Rankin Scale; mRS 0–2). Results: A total of 65 patients were included, DCM was identified in 22 patients (33.8%). Patients with DCM had significantly higher pre-procedural intravenous tissue plasminogen activator (IV-tPA) administration (81.8 vs. 53.5%, p = 0.03), stentrievers thrombectomy (95.5 vs. 62.8%, p = 0.006), and longer median puncture to recanalization time (44 [34–97] vs. 30 [20–56] min, p = 0.028) as compared to group with non-DCM. Also, they had lower rates of Thrombolysis in Cerebral Infarction (TICI) 2b/3 recanalization (p = 0.002), higher median National Institutes of Health Stroke Scale (NIHSS) scores at discharge (p = 0.01), and lower rates of 90-day mRS (0–2; 18.2 vs. 48.8%; p = 0.016). On subgroup analysis, patients with middle cerebral artery occlusions who underwent MT with stentrievers <40 mm in length had a higher risk of DCM (p = 0.026). On multivariable analysis, IV-tPA administration (OR; 5.019, 95% CI [1.319–19.102], p = 0.018) and stentrievers thrombectomy (OR; 10.031, 95% CI [1.090–92.344]; p = 0.04) remained significant predictors of DCM. Baseline NIHSS score (OR; 0.872, 95% CI [0.788–0.965], p = 0.008) and DCM (OR; 0.250, 95% CI [0.075–0.866], p = 0.03) were independent predictors of 90-day mRS 0–2. Conclusion: In patients undergoing MT for anterior circulation LVO, DCM is associated with lower rates of TICI 2b/3 recanalization and worse functional outcomes at 90 days. IV-tPA administration and MT with short stentrievers are independent predictors of DCM development.

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