Abstract Details

Title Outcomes of ischemic stroke with large vessel occlusion needing endovascular thrombectomy and hyper-acute stent placement

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 044

Objective To evaluate functional outcomes of stroke patients undergoing endovascular thrombectomy with intra-procedural stent placement.

Background The DAWN and DEFUSE trials extended the window for mechanical thrombectomy up to 24 hours from last known normal (LKN) in patients with internal carotid artery and/or proximal middle cerebral artery occlusion, with limits on core infarct and penumbra size. The outcome of patients who required anti-thrombotics for stent placement to maintain vessel patency, often in addition to tPA administration, is unknown.

Design/Methods An IRB approved, retrospective review was performed of consecutive stroke patients with ICA or proximal MCA occlusions presenting to a tertiary Comprehensive Stroke Center from 12/1/18-12/31/19 within 24 hours of LKN and undergoing thrombectomy with and without stent placement. The modified Rankin Scale (mRS) within 90 days was used as the primary outcome measure with a “functional outcome” defined as a score of ≤ 3.

Results Of the 95 patients, mean age 68 years (SD±15), 29 (31%) received tPA. Median core infarct volume was 11 cc (IQR 0 – 39 cc), median mismatch volume was 97 cc (IQR 68 – 146 cc) and median admission NIHSS was 15 (IQR 10-19). Twenty-nine patients (31%) underwent stent placement (26 extra-cranial and 3 intracranial). Median time to revascularization was 8.2 hours (IQR 4.5 – 13.9 hours). Patients undergoing stent placement were less likely to have a functional outcome within 90 days (41%) compared to non-stented patients (53%) after controlling for age, gender, BMI, NIHSS, tPA administration, mismatch volume and time to revascularization, but this finding did not reach statistical significance (p=0.080).

Conclusions In our study, patients who underwent stent placement during endovascular thrombectomy were less likely to have a functional outcome within 90 days. Larger studies are needed to confirm this finding and reveal the associated factors.

Authors/Disclosures
Karl J. Wold, MD PRESENTER	Mr. Wold has nothing to disclose.
Owen T. Owens, DO (Intermountain Healthcare)	Dr. Owens has nothing to disclose.
Asish K. Gulati, DO (The GW MFA Associates)	Dr. Gulati has nothing to disclose.
Amy K. Guzik, MD, F�鶹��ýӳ�� (Wake Forest University Baptist Medical Center)	Dr. Guzik has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Local law firms, available by request.
Patrick S. Reynolds, MD, F�鶹��ýӳ�� (Wake Forest University Health Sciences)	Dr. Reynolds has nothing to disclose.
Sudhir V. Datar, MD (Wake Forest Baptist Medical Center)	Dr. Datar has nothing to disclose.

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