Abstract
Abstract TMP85: Endovascular Thrombectomy for Large Ischemic Strokes With Tandem Lesions: A SELECT2 Subanalysis
Stroke (1970), Vol.55(Suppl_1)
02/2024
DOI: 10.1161/str.55.suppl_1.TMP85
Abstract
Abstract only Introduction: Trials evaluating thrombectomy (EVT) efficacy and safety in large vessel occlusion (LVO) excluded patients with cervical tandem lesions (TL). We aimed to evaluate EVT efficacy and safety in large stroke patients with TL from the SELECT2 trial. Methods: SELECT2 was a randomized controlled trial evaluating EVT vs. medical management (MM) in patients with LVO ischemic strokes (ASPECTS 3-5 on computed tomography (CT) or ischemic core ≥50 ml on CT Perfusion/MR diffusion-perfusion). TL were defined as internal carotid artery occlusion with a concomitant LVO as determined by the core lab. Functional, safety, and imaging outcomes were compared between patients in EVT vs. MM. Results: Of 352 enrolled, 100 (28%) had tandem occlusions, with 56 receiving EVT. ASPECTS (EVT: 4 [3-5] vs. MM: 4 [4-5]), ischemic core estimates (EVT: 86 [58-133] ml vs. MM: 81 [61-121] ml) and critically hypoperfused tissue volume (EVT: 185 [131-266] ml vs. MM: 192 [142-252] ml) were similar between groups. TL Patients receiving EVT demonstrated significantly better functional outcomes (mRS at 90d: EVT 4[3-6] vs MM 5[4-6]; aGenOR: 2.22; 95%CI, 1.47-3.34; p<0.001), similar to those without TL (aGenOR: 1.59, 95% CI: 1.23-2.05, p<0.001; P-int-0.29) and a higher proportion of patients achieving functional independence (EVT: 20% vs. MM: 2%; aRR: 9.53; 95%CI, 1.71-53.21; p=0.010) and independent ambulation (EVT: 38% vs MM: 11%; aRR: 3.60; 95%CI, 1.68-7.67; p=0.001), with significantly reduced complete dependence or death (mRS 5-6) (aRR: 0.66 (0.48-0.90), p=0.009). There was no difference in symptomatic ICH (EVT: 2% vs MM: 0%) or parenchymal hemorrhage (EVT: 2% vs MM: 0%). Complications occurred in 10 (18%) patients receiving EVT. In the EVT group, successful reperfusion (mTICI 2b-3) was associated with better functional outcome (aGenOR: 2.30; 95%CI, 1.14-4.65; p=0.021). Conclusion: In patients with tandem lesions, EVT and successful reperfusion were associated with better functional outcomes. Frequency of vascular complications was similar to those without tandem lesions and no patients receiving immediate stenting demonstrated parenchymal hemorrhage. Our findings support consideration of EVT in patients with tandem lesions with large ischemic strokes. NCT03876457
Details
- Title: Subtitle
- Abstract TMP85: Endovascular Thrombectomy for Large Ischemic Strokes With Tandem Lesions: A SELECT2 Subanalysis
- Creators
- Santiago Ortega-Gutierrez - University of IowaEdgar A Samaniego - University of IowaJuan Vivanco-Suarez - Univ of Iowa Hosps, Iowa City, IAAmeer E Hassan - Valley Baptist Medical CenterMichael G Abraham - University of KansasMichael Chen - Rush UniversityMuhammad S Hussain - Cleveland ClinicLeonid Churilov - Royal Melbourne HospitalHannah Johns - Royal Melbourne HospitalVitor Mendes Pereira - St. Michael's HospitalDeep Pujara - University Hospitals of ClevelandFaris Shaker - The University of Texas Health Science Center at HoustonTareq Kass-Hout - University of ChicagoSpiros Blackburn - The University of Texas Health Science Center at HoustonMohammad A Abdulrazzak - Cleveland ClinicClark W Sitton - The University of Texas Health Science Center at HoustonMalik Ghannam - University of IowaEnrique C Leira - University of IowaHannah Roeder - University of IowaHeena M Olalde - University of IowaMaarten G Lansberg - Stanford UniversityMichael D Hill - University of CalgaryJames C Grotta - Memorial HermannGregory W Albers - Stanford UniversityMarc Ribo - Vall d'Hebron Hospital UniversitariBruce Campbell - Royal Melbourne HospitalAmrou Sarraj - University Hospitals of ClevelandThe SELECT2 Investigators
- Resource Type
- Abstract
- Publication Details
- Stroke (1970), Vol.55(Suppl_1)
- DOI
- 10.1161/str.55.suppl_1.TMP85
- ISSN
- 0039-2499
- eISSN
- 1524-4628
- Language
- English
- Date published
- 02/2024
- Academic Unit
- Neurosurgery; Epidemiology; Radiology; Neurology; Iowa Neuroscience Institute
- Record Identifier
- 9984557859902771
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