Abstract 1122‐000093: Association of Pre‐Mechanical Thrombectomy Collateral Scores with Functional‐Outcome in Short Versus Extended Window for Thrombectomy

Introduction : We aim to determine the utility of pre‐mechanical‐thrombectomy (MT) collateral scores in the short (<6 hours from onset) versus extended (6‐24 hours from onset) window for MT with respect to a good functional‐outcome. Methods : We performed a retrospective chart review of patients who underwent MT for anterior circulation LVO at a comprehensive stroke center from 7/2014 to 12/2020. A board‐certified neuroradiologist, who was blinded to the clinical‐outcomes, used collateral grading scales of Miteff (ordinal), Mass (ordinal), and modified‐Tan (dichotomous) to designate collateral scores on the pre‐MT CT Angiogram. The patients were divided into short (<6 hours from onset) versus extended (6‐24 hours from onset) groups depending on their timing of presentation to the emergency department. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, ASPECTS≥6, TICI score≥2b, recanalization time, mean arterial pressure, blood glucose, location of occlusion, atrial fibrillation, LDL, hemoglobin‐A1C, and administration of intravenous‐alteplase, with the pre‐MT collateral grading scores as predictors. The primary outcome was a good functional‐outcome (3‐month mRS≤2) Results : 162 patients met our inclusion criteria for patients who presented in the short window. The pre‐MT scales of Mass (OR, 0.35; 95%CI, 0.16‐0.78; P 0.01) and modified‐Tan (OR, 0.35; 95%CI, 0.16‐0.78; P 0.01) were associated with a good functional‐outcome, unlike the Miteff scale (OR, 0.46; 95% CI, 0.18‐1.18; P 0.103). 58 patients met our inclusion criteria for patients who presented in the extended window. The pre‐MT scales of Mass (OR, 0.75; 95% CI, 0.23‐2.48; P 0.63), Miteff scale (OR, 0.78; 95%CI, 0.17‐3.64; P 0.746) and modified‐Tan (OR, 1.14; 95%CI, 0.1‐12.98; P 0.918) were not associated with a good functional‐outcome. Conclusions : Our study demonstrates that good collateral grades on Mass and modified‐Tan scales are associated with a good functional outcome for patients who present to the ED in the short window for MT. We did not find an association of any pre‐MT collateral scores with a good functional‐outcome for patients presenting in the extended window for MT.

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Abstract 1122‐000123: Association of 24‐hour Blood Pressure Parameters Post‐Thrombectomy with Functional Outcomes According to Collateral Status

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000123 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Taha Nisar ◽

Toluwalase Tofade ◽

Konrad Lebioda ◽

Osama Abu‐Hadid ◽

Priyank Khandelwal

Keyword(s):

Blood Pressure ◽

Functional Outcome ◽

Retrospective Chart Review ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Good Functional Outcome ◽

Ct Angiogram ◽

Ischemic Brain Tissue ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction : Higher blood pressure (BP) most post mechanical thrombectomy (MT) can restore perfusion to the ischemic brain tissue depending on collateral status. We aim to determine the association of 24‐hour post‐MT BP parameters with the functional outcome depending on the pre‐MT collateral status. Methods : We performed a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2014 to 12/2020. The patients were divided into two groups (good versus bad) depending on collateral status. A board‐certified neuroradiologist, who was blinded to the clinical outcomes, used collateral grading scales of Mass ≥3 and modified‐Tan>50% to designate good collaterals on the pre‐MT CT Angiogram. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, ASPECTS≥6, TICI score≥2b, time to thrombectomy, LDL, Hemoglobin‐A1C, intravenous‐alteplase, with the 24‐hour post‐MT BP parameters as the predictors. The outcomes were good functional outcome (3‐month mRS≤2) and mortality. Results : 220 patients met the inclusion criteria. 24‐hour BP parameters of standard deviation (SD) SBP (OR, 1.16; 95% CI,1.01‐1.33; P 0.047) and maximum DBP (OR, 1.05; 95% CI,1.01‐1.09; P 0.036) had an association with a good functional outcome, while SD SBP (OR, 1.15; 95% CI,1.01‐1.31; P 0.045), coefficient variation (CV) SBP (OR, 1.19; 95% CI,1.01‐1.41; P 0.043), SBP range (OR, 1.04; 95% CI,1.01‐1.07; P 0.046), maximum DBP (OR, 0.95; 95% CI,0.91‐0.99; P 0.016), pulse pressure (OR, 1.09; 95% CI,1.02‐1.16; P 0.022) and SBP ≥140 (OR, 5.85; 95% CI,1.11‐30.85; P 0.038) had an association with mortality in patients with good collaterals according to Mass grading. 24‐hour BP parameters of SD SBP (OR, 1.13; 95% CI,1.04‐1.24; P 0.007), CV SBP (OR, 1.18; 95% CI,1.05‐1.32; P 0.006), SBP range (OR, 1.04; 95% CI,1.01‐1.06; P 0.008) and maximum DBP (OR, 0.97; 95% CI,0.94‐1; P 0.02) had an association with mortality in patients with good collaterals according to modified‐Tan grading. There was no such association in patients with bad collaterals Conclusions : Various 24‐hour BP parameters post‐MT are associated with a functional outcome or mortality in patients with good collaterals, unlike in patients with bad collaterals.

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Abstract P703: Association of Anemia With Functional Outcomes in Patients With Mechanical Thrombectomy

Stroke ◽

10.1161/str.52.suppl_1.p703 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Taha Nisar ◽

Osama Abu-hadid ◽

Toluwalase Tofade ◽

Sara Shapouran ◽

Muhammad Zeeshan Memon ◽

...

Keyword(s):

Functional Outcome ◽

Functional Outcomes ◽

Mechanical Thrombectomy ◽

Infarct Volume ◽

Retrospective Chart Review ◽

World Health ◽

Binary Logistic Regression Analysis ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Good Functional Outcome

Introduction: Anemia at presentation is associated with worse outcomes in patients with acute ischemic stroke. We aim to investigate the association of anemia upon presentation with functional outcomes in patients who undergo mechanical thrombectomy (MT). Methods: We performed a retrospective chart review of patients who underwent MT for anterior circulation large vessel occlusion at a comprehensive stroke center from 7/2014 to 5/2020. Anemia was considered a dichotomous categorical variable with a cutoff point of hemoglobin <12.0 g/dL in women and <13.0 g/dL in men, as per the definition of the World Health Organization. A binary logistic regression analysis was performed, controlling for age, pre-treatment-NIHSS, ASPECTS ≥6, TICI score ≥2b, onset to recanalization time, and administration of intravenous-alteplase (IV-rtPA), with the presence of anemia as the predictor. The primary outcome was a good functional outcome at 3-months (mRS of ≤1). The secondary outcomes were 3-month mortality, sICH (ECASS-II criteria), and infarct volume on follow-up CT Head. Results: 177 patients met our inclusion criteria. The mean age was 64.34±15.16 years. 93 (52.54%) patients were men. 34 (19.21%) patients had 3-month mRS≤1. 11 (6.21%) patients developed sICH. Among men, there was a significant association of anemia with lesser chance of good functional outcome (5.89% vs.23.73%; OR, 6.1; 95% CI, 1.3-30.5; P 0.028), higher mortality (52.94% vs.30.51%; OR, 2.9; 95% CI, 1.1-7.8; P 0.038), and a larger infarct volume (106.12±109.78mls vs.73.02±74.36mls.; OR, 1.1; 95% CI, 1.1-1.1; P 0.032), but not with sICH (5.89% vs.5.26%; OR, 1.6; 95% CI, 0.2-12.2; P 0.681). Among women, there was no significant association of anemia with any outcome measures: mRS ≤1 (25% vs.31.25%; OR, 0.84; 95% CI, 0.27-2.59; P 0.754), mortality (25% vs.23.08%; OR, 1.26; 95% CI, 0.4-3.97; P 0.693), infarct volume (60.08±94.46mls vs.69.05±97.74mls.; OR, 1; 95% CI, 1-1.01; P 0.981), and sICH (9.37% vs.5.89%; OR, 1.52; 95% CI, 0.26-8.88; P 0.643). Conclusions: Our study demonstrates a gender difference in outcomes in patients with anemia at presentation who undergo MT. In our cohort, men had an association between anemia and mRS≤1, mortality, and a larger infarct volume, unlike women.

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Impact of Repeated Clot Retrieval Attempts on Infarct Growth and Outcome After Ischemic Stroke

Neurology ◽

10.1212/wnl.0000000000012321 ◽

2021 ◽

pp. 10.1212/WNL.0000000000012321

Author(s):

Wagih Ben Hassen ◽

Caroline Touloupas ◽

Joseph Benzakoun ◽

Gregoire Boulouis ◽

Martin Bretzner ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Stroke ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Binary Logistic Regression ◽

Unfavorable Outcome ◽

Binary Logistic Regression Analysis ◽

Strongly Correlated ◽

Vessel Occlusion

Objective:To determine whether the association between increasing number of clot retrieval attempts (CRA) and unfavorable outcome is due to an increase in emboli to new territory (ENT) and greater infarct growth (IG) in successfully recanalized patients with acute ischemic stroke due to large vessel occlusion (AIS LVO).Methods:Data were extracted from two pooled multicentric prospective registries of consecutive anterior AIS-LVO patients treated with mechanical thrombectomy (MT) between January 2016-2019. Patients with pretreatment and 24 hours post-treatment diffusion-weighted imaging (DWI) achieving successful recanalization, defined as expanded Thrombolysis in Cerebral Infarction Scale (eTICI) scores 2b, 2C or 3 were included. ENT were assessed and IG measured by voxel-based segmentation after DWI co-registration. Associations between number of CRA, ENT, IG and 3-month outcome were analyzed.Results:Four hundred nineteen patients achieving successful recanalization were included. ENT occurrence was strongly correlated with increasing CRA (ρ=0.73, p=10-4). In multivariable linear analysis, IG was independently associated with CRA (β=1.6 per retrieval attempt, 95% CI = [0.97–9.74], p=0.03) and ENT (β=2.7, [1.21-4.1], p=0.03). Unfavorable functional outcome (3-month modified Rankin Score >2) increased with each additional CRA. IG was an independent predictor of unfavorable outcome (OR=1.05 [1.02-1.07] per 1 mL IG increase, p=10-4) in binary logistic regression analysis.Conclusion:Increasing number of CRA in acute stroke is correlated with an increased ENT rate and increased IG volume, affecting functional outcome even when successful recanalization is achieved.Classification of evidence:This study provides Class II evidence that, for patients with acute stroke undergoing successful recanalization, an increasing number of clot retrieval attempts is associated with poorer functional outcome.

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Abstract P539: Comparison of Transradial Artery versus Transfemoral Artery Access for Solumbra Technique in Mechanical Thrombectomy

Stroke ◽

10.1161/str.52.suppl_1.p539 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Taha Nisar ◽

Jimmy Patel ◽

Muhammad Z Memon ◽

Amit Singla ◽

Priyank Khandelwal

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Arrival Time ◽

Mechanical Thrombectomy ◽

Retrospective Chart Review ◽

Functional Independence ◽

Binary Logistic Regression Analysis ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Number Of Patients

Introduction: Solumbra technique involves the simultaneous use of stent-retriever and large-bore aspiration for clot retrieval in mechanical thrombectomy (MT). We aim to compare various time parameters in patients who undergo MT via solumbra technique via transradial artery (TRA) approach vs. transfemoral artery (TRF) approach. Methods: We performed a retrospective chart review of patients who underwent MT via solumbra technique for anterior circulation large vessel occlusion at a comprehensive stroke center from 7/2014 to 5/2020. We compared time to recanalization parameters, score of TICI≥2b, and functional independence (3-month mRS≤2) in patients who underwent MT via TRA vs.TRF approach via the solumbra technique. A binary logistic regression analysis was performed, controlling for age, sex, pre-treatment-NIHSS, type of anesthesia (general vs.moderate), laterality, and clot location [proximal (internal carotid or M1 segment of the middle cerebral artery) vs.distal (M2 or M3 segment of the middle cerebral artery)]. Results: A total of 98 patients met our inclusion criteria. The mean age was 63.59±14.40 years. 18 (18.37%) patients underwent MT through transradial approach. In our cohort, there was a significant association of TRA with shorter angio suite arrival-time to puncture-time (22.12±9.92mins vs.28.83±12.26mins; OR, 0.94; 95% CI, 0.88-1; P 0.026), but not with puncture-time to recanalization-time (84.34±61.34mins vs.63.73±35.29mins; OR, 1.01; 95% CI, 1-1.03; P 0.085), angio suite arrival-time to recanalization-time (103.12±51.29mins vs.93.42±39.08mins; OR, 1.01; 95% CI, 1-1.02; P 0.524), number of passes to recanalization (1.78±1.36 vs.1.68±1.05; OR, 1.03; 95% CI, 0.66-1.63 ; P 0.899), number of patients with TICI≥2b (83.34% vs.91.25%; OR, 0.68; 95% CI, 0.14-3.4; P 0.633), and functional independence (66.67% vs.78.75%; OR, 0.49; 95% CI, 0.13-1.86; P 0.292), when compared to TRF approach for MT using solumbra technique. Conclusion: Our study demonstrates a significant association between TRA approach with shorter angio suite arrival-time to puncture-time but not with overall time to recanalization, number of patients with TICI≥2b, and functional independence, when compared to TRF approach for MT using solumbra technique.

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Mechanical thrombectomy in nonagenarians with acute ischemic stroke

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-014785 ◽

2019 ◽

Vol 11 (11) ◽

pp. 1091-1094 ◽

Cited By ~ 17

Author(s):

Lukas Meyer ◽

Maria Alexandrou ◽

Hannes Leischner ◽

Fabian Flottmann ◽

Milani Deb-Chatterji ◽

...

Keyword(s):

Ischemic Stroke ◽

Elderly Patients ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Very Elderly ◽

Anterior Circulation ◽

Serious Adverse Events ◽

Good Functional Outcome ◽

Symptomatic Intracranial Hemorrhage

BackgroundMechanical thrombectomy (MT) is a safe and effective therapy for ischemic stroke. Nevertheless, very elderly patients aged ≥90 years were either excluded or under-represented in previous trials. It remains uncertain whether MT is warranted for this population or whether there should be an upper age limit.MethodsWe retrospectively reviewed 79 patients with stroke aged ≥90 years from three neurointerventional centers who underwent MT between 2013 and 2017. Good functional outcome was defined as modified Rankin scale (mRS) ≤2 and assessed at 90-day follow-up. Successful recanalization was graded by Thrombolysis in Cerebral Infarction Scale (TICI) ≥2 b. Feasibility and safety assessments included unsuccessful recanalization attempts (TICI 0), time from groin puncture to recanalization, symptomatic intracranial hemorrhage (sICH), mortality, and intervention-related serious adverse events.ResultsOnly occlusions within the anterior circulation were included. Median time from groin puncture to recanalization was 39 min (IQR 25–57 min). The rate of successful recanalization (TICI ≥2 b) was 69.6% (55/79). Good functional outcome (mRS ≤2) at 90 days was observed in 16% (12/75) of patients. In-hospital mortality was 29.1% (23/79) and increased significantly at 90 days (46.7%, 35/75; p<0.001). sICH occurred in 5.1% (4/79) of patients. No independent predictor for good functional outcome (mRS ≤2) at 90 days was identified through logistic regression analysis.ConclusionMT in nonagenarians leads to high mortality rates and less frequently good functional outcome compared with younger patient cohorts in previous large randomized trials. However, MT appears to be safe and beneficial for a certain number of very elderly patients and therefore should generally not be withheld from nonagenarians.

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Abstract 1122‐000175: Comparison of Transradial Artery Versus Transfemoral Artery Access Mechanical Thrombectomy at a Comprehensive Stroke Center

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.01.suppl_1.000175 ◽

2021 ◽

Vol 1 (S1) ◽

Author(s):

Taha Nisar ◽

Jimmy Patel ◽

Amit Singla ◽

Priyank Khandelwal

Keyword(s):

Mechanical Thrombectomy ◽

Retrospective Chart Review ◽

Functional Independence ◽

Binary Logistic Regression Analysis ◽

Transfemoral Approach ◽

Outcome Parameters ◽

Significant Difference ◽

First Pass ◽

Comprehensive Stroke Center ◽

Stroke Center

Introduction : The transradial approach (TRA) is being increasingly adopted by neuro‐interventionists and has emerged as an alternative to the traditional transfemoral approach (TFA) for mechanical thrombectomy (MT). We aim to compare various time, technical and outcome parameters in patients who undergo MT via TRF vs. TRA approach. Methods : We performed a retrospective chart review of patients who underwent MT at a comprehensive stroke center from 7/2016 to 12/2020. We compared patients who underwent MT via TRA vs. TRF with respect to time from angio suite arrival to puncture, first pass, second pass and recanalization; time from puncture to first pass, second pass and recanalization; time from arrival to the emergency department (ED) to puncture, first pass, second pass and recanalization; the number of passes, rate of switching, achievement of TICI≥2b score, functional independence (3‐month mRS≤2), 3‐month mortality and neurological improvement (improvement in NIHSS by ≥4 points) on day 1 and 3. A binary logistic regression analysis was performed, controlling for age, sex, NIHSS, type of anesthesia (general vs. moderate), laterality, and location of clot (internal carotid or middle cerebral artery), ASPECTS≥6, presenting mean arterial pressure, blood glucose, Hb A1C, LDL, intravenous alteplase. Results : 217 patients met our inclusion criteria. The mean age was 64.09±14.4 years. 42 (19.35%) patients underwent MT through the TRA approach. There was a significantly higher rate of conversion from TRA approach to TRF approach (11.90% vs.2.28%; OR, 105.59; 95% CI,5.71‐1954.67; P 0.002), but no difference in various time, technical and outcome parameters, as shown in the table. Conclusions : Our study demonstrates no significant difference between TRA and TRF approaches with respect to various time, technical and outcome parameters, with a notable exception of a significantly higher rate of conversion from TRA to TRF approach.

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General Anesthesia Versus Conscious Sedation for Mechanical Thrombectomy in Acute Anterior Circulation Ischemic Stroke

Stroke: Vascular and Interventional Neurology ◽

10.1161/svin.121.000130 ◽

2021 ◽

Author(s):

Liqun Zhang ◽

Judith Dinsmore ◽

Usman Khan ◽

Joe Leyon ◽

Ayokunle Ogungbemi ◽

...

Keyword(s):

Ischemic Stroke ◽

General Anesthesia ◽

Functional Outcome ◽

Mechanical Thrombectomy ◽

Conscious Sedation ◽

Arterial Puncture ◽

Binary Logistic Regression Analysis ◽

Anterior Circulation ◽

The Impact ◽

Favorable Functional Outcome

BACKGROUND Retrospective studies suggested that general anesthesia (GA) for mechanical thrombectomy has worse outcomes compared with conscious sedation (CS). However, randomized single‐center trials suggested noninferiority of GA to CS. We investigated the impact of anesthesia techniques on thrombectomy, and hypothesized that the routine use of GA with a defined protocol would not adversely affect thrombectomy delivery or outcomes. METHODS A total of 451 consecutive patients receiving mechanical thrombectomy for anterior circulation ischemic stroke from 2016 to 2019 were identified from the local registry. Patients were divided into cohort A when both GA and CS were used, and cohort B (from October 2017) when GA became the default method. Favorable functional outcome was defined as modified Rankin scale of 0 to 2 at 3 months. Intraprocedural blood pressures were audited annually. RESULTS In cohort A, compared with patients receiving CS, patients with GA had prolonged median arrival to arterial puncture time (26 versus 18 minutes; P <0.001) and comparable favorable functional outcome at 3 months (37.7% versus 45.1%; P =0.355). In cohort B, the median arrival to arterial puncture was reduced to 10 minutes, with comparable favorable functional outcome of 46.7%, and reduced mortality compared with cohort A (14.2% versus 22.7%; P =0.024). Yearly audits demonstrated good adherence to the protocol. Binary logistic regression analysis showed only old age (odds ratio [OR], 1.04; 95% CI, 1.02–1.07 [ P =0.003]), high National Institute of Health Stroke Scale at presentation (OR, 1.17; 95% CI, 1.08–1.26 [ P <0.001]), and poor collateral status (OR, 0.29; 95% CI, 0.12–0.72 [ P =0.008]) were independent factors predicting for poor prognosis, not GA (OR, 0.71; 95% CI, 0.32–1.60 [ P =0.408]). CONCLUSIONS Patients treated under GA for mechanical thrombectomy achieved comparable functional outcome at 3 months compared with those under CS. Through practice and a defined protocol, GA for mechanical thrombectomy can achieve sustainable good functional outcomes. Large clinical trials are needed to confirm these findings.

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Internal Carotid Artery and the Proximal M1 Segment Are Optimal Targets for Mechanical Thrombectomy

Interventional Neurology ◽

10.1159/000475606 ◽

2017 ◽

Vol 6 (3-4) ◽

pp. 207-218 ◽

Cited By ~ 2

Author(s):

Niko Sillanpää ◽

Sara Protto ◽

Jukka T. Saarinen ◽

Juha-Pekka Pienimäki ◽

Janne Seppänen ◽

...

Keyword(s):

Clinical Outcome ◽

Mechanical Thrombectomy ◽

Statistical Tests ◽

Intravenous Thrombolysis ◽

Binary Logistic Regression ◽

Binary Logistic Regression Analysis ◽

Good Clinical Outcome ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Outcome Differences

Background and Purpose: Mechanical thrombectomy (MT) is an established treatment of acute anterior circulation stroke caused by large vessel occlusion (LVO). We compared the clinical outcome (3-month modified Rankin Scale, mRS) in hyperacute (<3h from the onset of symptoms) ischemic stroke between an MT and an intravenous thrombolysis (IVT) cohort in proximal (ICA and the proximal M1 segment of the middle cerebral artery) and distal (the distal M1 and the M2 segment) LVOs. Methods: We prospectively reviewed 67 patients who underwent MT with newer-generation stent retrievers. The IVT cohort consisted of 98 patients who received IVT without MT. We recorded baseline clinical, procedural and imaging variables, technical outcome, 24-h imaging outcome, and the clinical outcome. Differences between the groups were studied with theoretically appropriate statistical tests and binary logistic regression analysis. Results: The proportion of patients who had a proximal LVO and experienced good (mRS ≤2) or excellent (mRS ≤1) clinical outcome was significantly larger in the MT group (62 vs. 7%, p < 0.001; 47 vs. 3%, p < 0.001, respectively). In a regression model including relevant confounding variables, good clinical outcome was seen significantly more often among patients with proximal occlusions (OR = 6.0, CI 95% 1.9-18.3, p = 0.002). In a similar model, no statistically significant differences were observed in patients with more distal occlusions. Conclusions: MT is superior to IVT in achieving good clinical outcome in hyperacute anterior circulation stroke in the most proximal occlusions (ICA and proximal M1 segment). In the distal M1 and M2 segments neither of these therapies clearly outperforms the other.

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First attempt recanalization with ADAPT: rate, predictors, and outcome

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014294 ◽

2018 ◽

Vol 11 (7) ◽

pp. 641-645 ◽

Cited By ~ 11

Author(s):

Mohammad Anadani ◽

Ali Alawieh ◽

Jan Vargas ◽

Arindam Rano Chatterjee ◽

Aquilla Turk ◽

...

Keyword(s):

Functional Outcome ◽

Mechanical Thrombectomy ◽

Functional Independence ◽

Hemorrhagic Transformation ◽

Lower Mortality ◽

Anterior Circulation ◽

Tandem Occlusion ◽

First Pass ◽

Baseline Characteristics ◽

Iv Tpa

IntroductionThe rate of first-attempt recanalization (FAR) with the newer-generation thrombectomy devices, and more specifically with aspiration devices, is not well known. Moreover, the effect of FAR on outcomes after mechanical thrombectomy is not properly understood.ObjectiveTo report the rate of FAR using a direct aspiration first pass technique (ADAPT), investigate the association between FAR and outcomes, and identify the predictors of FAR.MethodsThe ADAPT database was used to identify a subgroup of patients in whom FAR was achieved. Baseline characteristics, procedural, and postprocedural variables were collected. Outcome measures included 90-day modified Rankin scale (mRS) score, mortality, and hemorrhagic complications. Multivariate logistic regression was used to identify FAR predictors.ResultsA total of 524 patients was included of whom 178 (34.0%) achieved FAR. More patients in the FAR group than in the non-FAR group received IV tPA (46.6% vs 37.6%; p<0.05). For the functional outcome, higher proportions of patients in the FAR group achieved functional independence (mRS score 0–2; 53% vs 37%; p<0.05). Additionally, we observed lower mortality and hemorrhagic transformation rates in the FAR group than the non-FAR group. Independent predictors of FAR in the anterior circulation were pretreatment IV tPA, non-tandem occlusion, and use of larger reperfusion catheters (Penumbra, ACE 64–68). Independent predictors of FAR in the posterior circulation were diabetes, onset-to-groin time, and cardioembolic etiology.ConclusionFAR was associated with better functional outcome and lower mortality rate. When ADAPT is used, a larger aspiration catheter and pretreatment IV tPA should be employed when indicated.

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Abstract TP10: Selection Criteria, Is The Clue To Successful Thrombectomy?

Stroke ◽

10.1161/str.44.suppl_1.atp10 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Pedro Cardona ◽

Helena Quesada ◽

Luis Cano ◽

Lucia Aja ◽

De Miquel MA. ◽

...

Keyword(s):

Acute Stroke ◽

Functional Outcome ◽

Selection Criteria ◽

Intravenous Thrombolysis ◽

Correct Selection ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Anterior Circulation ◽

Vessel Occlusion ◽

Stroke Treatment

In our comprehensive stroke center we analyze correct selection criteria to use self-expandable retrievable intracranial stents for acute stroke treatment. The criteria for intervention were the onset of neurological symptoms, a National Institute of Health Stroke Scale Score (NIHSS) ≥9 at presentation, large vessel occlusion stroke demonstrated by angio-CT, and failure of intravenous thrombolysis or exclusion criteria to administrate it. METHODS: We performed an retrospective analysis of 512 consecutive patients with acute ischemic stroke candidates for thrombectomy, from April of 2010 to June of 2012, that met inclusion criteria for intervention. Experienced vascular neurologists selected 171 patients to undergoing endovascular therapy using retrievable stents (Solitaire,Trevo). Successful recanalization results were assessed by follow-up angiography immediately after the procedure (TIMI 2-3/TICI 2b-3 score), and good functional outcome was considered when ≤2 mRankin score (mRS) was achieved at 90 days. RESULTS: A total of 171 patients were treated, 87% with anterior circulation stroke. The mean age was 67.5 years (range 32-87); 58% men. The median NIHSS at presentation was 17 (range 6-26). Recanalization (TICI 2b-3) was achieved in 73% of patients. Symptomatic hemorrhage occurred in 8%. Ninety-day mortality was 19, 5% and good 90-day functional outcome (mRS ≤2) was achieved by 45%. Unsuccessful recanalization (TICI 0-2a) was a significant predictor of poor outcome (mRS≤2: 9%). When we analyzed these patients according to inclusion criteria of IMS trial, 101 patients who met strict criteria achieved good neurological outcome more frequently (51% versus 34%) and significant lower mortality rates (17% vs 28%) compared with the group of 70 patients with IMS exclusion criteria. CONCLUSIONS: Efficacy in recanalization, safety of thrombectomy and its consequent good clinical outcome is sufficiently established. It is important an experienced vascular neurologist to select possible candidates (proportion of evaluated/treated patients 3:1). Inclusion criteria for acute stroke trials do not always represent real population of stroke patients as well as their clinical results.

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