Â鶹´«Ã½Ó³»­

Â鶹´«Ã½Ó³»­

Explore the latest content from across our publications
Join The Â鶹´«Ã½Ó³»­

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

A Single-center Comprehensive Stroke Center Experience of Endovascular Therapy vs Medical Management in the Extended Window with Poor ASPECTS
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
029

This study will explore the long-term functional and safety outcomes of endovascular therapy vs medical management in patients with anterior circulation large vessel occlusion (LVO) and poor ASPECTS (<6) presenting in the extended window (6-24 hours after last known well). 

The HERMES collaboration demonstrated that EVT within 6 hours of anterior LVO and poor ASPECTS is associated with better long-term outcomes than medical management.1,2 The benefit of EVT in patients in the extended window with poor ASPECTS is unclear.
A single-center retrospective cohort of adult patients admitted 04/2015-07/2020 with anterior LVO and poor ASPECTS who underwent EVT in the extended window was compared to a contemporaneous group that received only medical management. The odds of poor long-term outcome (3-month modified Rankin Scale score 3-6) were estimated using logistic regression, and adjusted for age and baseline NIHSS.
Of 324 patients who underwent thrombectomy during the study period, after excluding 40 patients with unavailable initial CT, 20 patients met inclusion criteria (7.04%), 8 of whom underwent EVT. EVT was not associated with higher odds of poor long-term outcome in unadjusted (OR 0.818, 95%CI 0.023-28.598) or adjusted logistic regression (adjusted OR 0.811, 95%CI 0.23-28.598), although most patients in both groups were ultimately transitioned to comfort measures during hospitalization (63% EVT and 67% medical management). There were no cases of sICH in patients who had undergone EVT or medical management.
Preliminary findings from this single-center retrospective cohort suggest EVT was associated with similar, poor long-term functional outcomes when compared to medical management in patients with low ASPECTS who presented in the extended time window. Any benefit of EVT in this cohort may be confounded by the high proportion of patients who transitioned to comfort care. A subgroup analysis of patients who pursued intensive medical treatment is planned once a larger sample size is reached.
Authors/Disclosures
Ameena Rana, MD (Mount Sinai Health System)
PRESENTER 		Dr. Rana has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Tudor G. Jovin, MD (Cooper University Healthcare) Dr. Jovin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Jovin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Contego Medical. Dr. Jovin has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Several law firms. Dr. Jovin has stock in Corindus. Dr. Jovin has stock in Methinks. Dr. Jovin has stock in Viz.ai. Dr. Jovin has stock in Route92. Dr. Jovin has stock in FreeOx Biotech. Dr. Jovin has stock in Galaxy. Dr. Jovin has stock in Kandu. The institution of Dr. Jovin has received research support from Stryker. The institution of Dr. Jovin has received research support from Medtronic.
Jesse Thon, MD (Cooper University Hospital) An immediate family member of Dr. Thon has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech.
No disclosure on file
James E. Siegler III, MD (University of Chicago) Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siegler has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bayer. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Serb. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Wallaby Phenox. Dr. Siegler has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke: Vascular and Interventional Neurology. Dr. Siegler has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Precision Medicine, LLC. The institution of Dr. Siegler has received research support from Philips. The institution of Dr. Siegler has received research support from Medtronic.