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Abstract Details

Mechanical Thrombectomy in Acute Ischemic Stroke in the Extended Window(6-24 hours) with Minimal Mismatch Volume(<15mL) on CT Perfusion Imaging: A Case Series
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
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To draw attention to patients who may benefit from mechanical thrombectomy in the extended window with low mismatch volume (<15mL) on computed tomography (CT) perfusion
Mechanical endovascular reperfusion (MER) for stroke in the extended [6-24 hours from last known well (LKW)] window is supported by strong evidence from several clinical trials. The use of strict selection criteria in the DAWN and DEFUSE3 trials to identify adequate collateral flow to the ischemic penumbra allowed for selection of patients most likely to benefit from MER. While the DAWN trial looked at patients with an NIHSS of ≥10, the DEFUSE3 trial selected patients with an NIHSS of ≥6, core infarct volume ≤ 30mL, reversible ischemia represented by mismatch volume of ≥15mL, and mismatch ratio of ≥1.8. Our case series aims to explore the potential benefit of MER in patients excluded by imaging criteria in the extended time window.
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Case 1: A 64-year-old female presented to our institution with left hemiplegia (NIHSS 13). CT angiography and perfusion revealed a right distal M1 occlusion with mismatch volume of 13mL. Mechanical thrombectomy was performed with groin puncture at 11.5 hours after LKW (TICI 2B). NIHSS was 7 on discharge.

Case 2: A 60-year-old male patient presented to our institution with aphasia and right hemiparesis(NIHSS 8). CT angiogram and perfusion revealed an incomplete occlusion of distal left M2 and mismatch volume of 5mL. Mechanical thrombectomy was performed with groin puncture at 7.5 hours from LKW (TICI 2B). NIHSS was 0 on discharge.
Our limited case series suggests a hypothesis that adherence to strict imaging criteria may exclude patients with low mismatch volume who could benefit from MER in the extended window. Further study with a large cohort would be needed to explore this group of potential patients.
Authors/Disclosures
Karan Philip, MBBS
PRESENTER 		Dr. Philip has nothing to disclose.
Carlos Ynigo D. Lopez, MD Dr. Lopez has nothing to disclose.
Hesham Masoud, MD (Department of Neurology) Dr. Masoud has nothing to disclose.