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

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 WMP20: Effect of Leukoaraiosis on Outcomes of Mechanical Thrombectomy and Proposed New Leukoaraiosis-Aspects Score

Stroke ◽

10.1161/str.51.suppl_1.wmp20 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Waleed Brinjikji ◽

John Benson ◽

Alejandro A Rabinstein ◽

David F Kallmes

Keyword(s):

Mechanical Thrombectomy ◽

Primary Outcome Measure ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Endovascular Thrombectomy ◽

Endovascular Recanalization ◽

Poor Outcomes ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Fazekas Scale

Background and Purpose: Leukoaraiosis is a poor prognostic marker for patients with acute ischemic stroke (AIS). This study sought to assess if severity of leukoaraiosis is associated with outcome in patients with AIS following endovascular thrombectomy, and to propose a leukoaraiosis-related modification to the ASPECTS score to improve its predictive value for good outcome. Methods: We analyzed consecutive patients with AIS that underwent mechanical thrombectomy for anterior circulation large vessel occlusion at our comprehensive stroke center. Leukoaraiosis burden was graded using the Fazekas scale (combined scores from two locations categorically divided into no leukoaraiosis (score = 0), mild (1-2), moderate (3-4) and severe (5-6)). The primary outcome measure was 90-day mRS. A proposed Leukoaraiosis-ASPECTS (“L-ASPECTS”) was calculated by subtracting values from the traditional ASPECT based on leukoaraiosis severity (1 point subtracted if mild, 2 if moderate, 3 if severe). Results: Of 174 included patients, 89 (51.2%) were female; average age was 68.0±9.1. 28 (16.1%) had no leukoaraiosis, 66 (37.9%) had mild, 62 (35.6%) had moderate, and 18 (10.3%) had severe. Leukoaraiosis severity was associated with worse 90-day mRS among all patients (p=0.0005) as well as those that were successfully revascularized (p=0.0002). A multivariate analysis confirmed that leukoaraiosis burden was associated with worse 90-day mRS among all patients (mild: p=0.006; moderate: p=0.002; severe: p=0.03), as well as those that underwent successful thrombectomies (p=0.005). Both L-ASPECTS and ASPECTS were associated with poor outcomes, but the association was stronger with L-ASPECTS (p<0.0001 and AUC=0.7 for L-ASPECTS; p=0.04 and AUC=0.59 for ASPECTS). Conclusion: Leukoaraiosis severity on pre-mechanical thrombectomy NCCT is associated with worse 90-day outcome in patients with AIS following endovascular recanalization, and is an independent risk factor for worse outcomes. A proposed L-ASPECTS score had stronger association with outcome than the traditional ASPECTS score.

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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?

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016045 ◽

2020 ◽

pp. neurintsurg-2020-016045 ◽

Cited By ~ 1

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.

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Predictive Factors for the Need of Tracheostomy in Patients With Large Vessel Occlusion Stroke Being Treated With Mechanical Thrombectomy

Frontiers in Neurology ◽

10.3389/fneur.2021.728624 ◽

2021 ◽

Vol 12 ◽

Author(s):

Ilko L. Maier ◽

Katarina Schramm ◽

Mathias Bähr ◽

Daniel Behme ◽

Marios-Nikos Psychogios ◽

...

Keyword(s):

Logistic Regression ◽

Length Of Stay ◽

Mechanical Thrombectomy ◽

Multivariate Logistic Regression Analysis ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Vessel Occlusion ◽

Icu Stay ◽

Icu Length Of Stay ◽

Symptomatic Intracerebral Hemorrhage

Background: Patients with large vessel occlusion stroke (LVOS) eligible for mechanical thrombectomy (MT) are at risk for stroke- and non-stroke-related complications resulting in the need for tracheostomy (TS). Risk factors for TS have not yet been systematically investigated in this subgroup of stroke patients.Methods: Prospectively derived data from patients with LVOS and MT being treated in a large, academic neurological ICU (neuro-ICU) between 2014 and 2019 were analyzed in this single-center study. Predictive value of peri- and post-interventional factors, stroke imaging, and pre-stroke medical history were investigated for their potential to predict tracheostomy during ICU stay using logistic regression models.Results: From 635 LVOS-patients treated with MT, 40 (6.3%) underwent tracheostomy during their neuro-ICU stay. Patients receiving tracheostomy were younger [71 (62–75) vs. 77 (66–83), p < 0.001], had a higher National Institute of Health Stroke Scale (NIHSS) at baseline [18 (15–20) vs. 15 (10–19), p = 0.009] as well as higher rates of hospital acquired pneumonia (HAP) [39 (97.5%) vs. 224 (37.6%), p < 0.001], failed extubation [15 (37.5%) vs. 19 (3.2%), p < 0.001], sepsis [11 (27.5%) vs. 16 (2.7%), p < 0.001], symptomatic intracerebral hemorrhage [5 (12.5%) vs. 22 (3.9%), p = 0.026] and decompressive hemicraniectomy (DH) [19 (51.4%) vs. 21 (3.8%), p < 0.001]. In multivariate logistic regression analysis, HAP (OR 21.26 (CI 2.76–163.56), p = 0.003], Sepsis [OR 5.39 (1.71–16.91), p = 0.004], failed extubation [OR 8.41 (3.09–22.93), p < 0.001] and DH [OR 9.94 (3.92–25.21), p < 0.001] remained as strongest predictors for TS. Patients with longer periods from admission to TS had longer ICU length of stay (r = 0.384, p = 0.03). There was no association between the time from admission to TS and clinical outcome (NIHSS at discharge: r = 0.125, p = 0.461; mRS at 90 days: r = −0.179, p = 0.403).Conclusions: Patients with LVOS undergoing MT are at high risk to require TS if extubation after the intervention fails, DH is needed, and severe infectious complications occur in the acute phase after ischemic stroke. These factors are likely to be useful for the indication and timing of TS to reduce overall sedation and shorten ICU length of stay.

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Abstract P263: Do Different Sites of Vessel Occlusion Dictate the Need for Intubation Prior to Endovascular Treatment and Have an Effect on Outcome?

Stroke ◽

10.1161/str.52.suppl_1.p263 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Ameer E Hassan ◽

Victor M Ringheanu ◽

Raul G Nogueira ◽

Laurie Preston ◽

Adnan I Qureshi ◽

...

Keyword(s):

Endovascular Treatment ◽

Functional Independence ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Number Of Patients ◽

Baseline Characteristics ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Proven Method ◽

Morbid Conditions

Introduction: Endovascular treatment (EVT) is a widely proven method to treat patients diagnosed with intracranial large vessel occlusion. In order to ensure patients safety prior to and during EVT, preprocedural intubation has been adopted in many centers as a means for airway protection and immobilization. However, the correlation between site of vessel occlusion, need for intubation, and outcomes, has not yet been established. Methods: Through the utilization of a prospectively collected database at a comprehensive stroke center between 2012-2020, demographics, co-morbid conditions, intracerebral hemorrhage, mortality rate, and functional independence outcomes were examined. The outcomes and sites of occlusion between patients receiving mechanical thrombectomy (MT) treated while intubated versus those treated under conscious sedation (CS) were compared. Results: Out of 625 patients treated with MT, a total of 218 (34.9%) were treated while intubated (average age 70.3 ± 13.7, 37.2% women), and 407 (65.1%) were treated while under CS (average age 70.3 ± 13.7, 47.7% women); see Table 1 for baseline characteristics and outcomes. A higher number of patients requiring intubation had an occlusion in the basilar versus those only requiring CS. No differences were noted in regard to the proportion of patients receiving intubation or CS when treated for RMCA, LMCA, or internal carotid artery occlusions. Conclusion: Intubation + MT was associated with significantly worsened outcomes in regard to recanalization rates, functional outcome, and mortality. In anterior circulation strokes, intubation in RMCA patients were found to have poorer clinical outcome. Higher rates of intubation were also found to be needed in patients with basilar occlusions. Further research is required to determine whether site of occlusion dictates the need for intubation, and whether intubation allows for favorable outcome between R and LMCA occlusions.

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Abstract MP35: Blood Pressure Reductions Before Arrival at a Thrombectomy-Capable Hospital Are Associated With Neurologic Worsening in Patients With Large-Vessel Occlusion

Stroke ◽

10.1161/str.52.suppl_1.mp35 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Jessica Kobsa ◽

Ayush Prasad ◽

Alexandria Soto ◽

Sreeja Kodali ◽

Cindy Khanh Nguyen ◽

...

Keyword(s):

Blood Pressure ◽

Management Strategies ◽

Vessel Occlusion ◽

Time Points ◽

Good Outcome ◽

Primary Stroke Center ◽

Poor Outcomes ◽

Comprehensive Stroke Center ◽

Stroke Center ◽

Radiographic Data

Introduction: Decreases in blood pressure (BP) during thrombectomy are associated with infarct progression and worse outcomes. Many patients present first to a primary stroke center (PSC) and are later transferred to a comprehensive stroke center (CSC) to undergo thrombectomy. During this period, important BP variations might occur. We evaluated the association of BP reductions with neurological worsening and functional outcomes. Methods: We prospectively collected hemodynamic, clinical, and radiographic data on consecutive patients with LVO ischemic stroke who were transferred from a PSC for possible thrombectomy between 2018 and 2020. We assessed systolic BP (SBP) and mean arterial pressure (MAP) at five time points: earliest recorded, average pre-PSC, PSC admission, average PSC, and CSC admission. We measured neurologic worsening as a change in NIHSS (ΔNIHSS) from PSC to CSC >3 and functional outcome using the modified Rankin Scale (mRS) at discharge and 90 days. Relationships between variables of interest were evaluated using linear regression. Results: Of 91 patients (mean age 70±16 years, mean NIHSS 12) included, 13 (14%) experienced early neurologic deterioration (ΔNIHSS>3), and 34 (37%) achieved a good outcome at discharge (mRS<3). We found that patients with good outcome had significantly lower SBP at all five assessed time points compared to patients with poor outcome (Figure 1, p<0.05). Percent change in MAP from initial presentation to CSC arrival was independently associated with ΔNIHSS after adjusting for age, sex, and transfer time (p=0.03, β=0.27). Conclusions: Patients with poor outcomes have higher BP throughout the pre-CSC period, possibly reflecting an augmented hypertensive response. Reductions in SBP and MAP before arrival at the CSC are associated with neurologic worsening. These results suggest that BP management strategies in the pre-CSC period to avoid large reductions in BP may improve outcomes in patients affected by LVO stroke.

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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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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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Abstract P469: Device-Related Dimensions and Their Effect on First Pass Success and Safety Outcomes After Mechanical Thrombectomy: Is Longer Safer?

Stroke ◽

10.1161/str.52.suppl_1.p469 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Mahmoud Dibas ◽

Sohum Desai ◽

WONDWOSSEN TEKLE ◽

Sherief Ghozy ◽

Adam A Dmytriw ◽

...

Keyword(s):

Mechanical Thrombectomy ◽

Mass Effect ◽

Mortality Rates ◽

Hemorrhagic Transformation ◽

Symptomatic Intracerebral Hemorrhage ◽

First Pass ◽

Safety Outcomes ◽

The Mean ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction: Mechanical thrombectomy (MT) results in a marked improvement in outcomes of acute ischemic stroke (AIS) patients. First pass effect (FPE), which is defined as the achievement of complete recanalization (mTICI 3) from a single pass, appears to be associated with higher rates of good outcome. We seek to determine if dimensions of stentreivers such as length and diameter have influence on FPE, and other safety outcomes including hemorrhagic transformation, symptomatic intracerebral hemorrhage (sICH), masseffect, and mortality. Methodology: Patients who underwent MT between 2012 and 2020 were identified from a prospectively maintained database at a comprehensive stroke center. Then, these patients were stratified based on dimensions of stentrievers into: "4x20", "4x40", "6x30", and “6x40". Stentrievers used during the study period included Trevo and Solitare. Results: This study included 320 AIS patients. The mean (SD) age of the included patients was 70.7 (13.5), and 54.1% of them were males. 79 (24.7%) of the stentrievers were 4x20, 47 (14.7%) were 4x40, 66 (20.6%) were 6x30, while 128 (40%) were 6x40. There was no difference among the four stentreivers in FPE rates (64.6% vs 68.1%, 66.7%, 67.2%, p=0.98), hemorrhagic transformation (10.1% vs 14.9%, 12.1%, 14.8%, p=0.88), mass effect (3.8% vs 6.4%, 9.1%, 11.7%, p=0.134), and mortality rates (17.7% vs 23.7%, 19.7%, 20.3%, p=0.86). Noteworthy, sICH was significantly different among the groups with the lowest rates reported for 4x40 (4.3%) and 6x40 (5.5%), followed by 4x20 (10.1%), and 6x30 (16.7%), respectively (p=0.04). Conclusions: Stentriever dimensions do not appear to significantly influence FPE rates. We found that 4x40 and 6x40 stentrievers were significantly associated with lower rates of sICH.

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