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E-224 Outcomes of mechanical thrombectomyin stroke patients with extreme large infarction core
Abstract   Open access   Peer reviewed

E-224 Outcomes of mechanical thrombectomyin stroke patients with extreme large infarction core

E Almallouhi, M Anadani, S Elawady, M Mahdi Sowlat, I Maier, P Jabbour, J Kim, S Quintero Wolfe, A Rai, R Starke, …
Journal of neurointerventional surgery, Vol.15(Suppl 1), pp.A212-A212
07/01/2023
DOI: 10.1136/jnis-2023-SNIS.323
url
https://doi.org/10.1136/jnis-2023-SNIS.323View
Published (Version of record) Open Access

Abstract

Introduction Recent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). However, limited data is available about the outcomes of MT in LVO patients presenting with extreme large infarction core (Alberta Stroke Program Early CT Score (ASPECTS) of 0-2). Methods Data from Stroke Thrombectomy and Aneurysm Registry (STAR), which combined the prospectively maintained databases of 84 thrombectomy-capable stroke centers in the US, Europe, and Asia, was interrogated. We identified thrombectomy patients presenting with an occlusion in the intracranial internal carotid artery (ICA) or M1 segment of the middle cerebral artery (MCA) and extreme large infarction core (ASPECTS 0-2). Patients with tandem occlusion were excluded from these analyses. Favorable outcome was defined by achieving achieved modified Rankin scale (mRS) of 0-2 at 90 days post-MT. Successful recanalization was defined by achieving a Modified Thrombolysis in Cerebral Infarction (mTICI) score of ≥2B. Results We identified 47 patients who presented with ASPECTS 0-2 and underwent MT (24 had M1 occlusion and 23 had intracranial ICA occlusion). The average age was 69.4; 26 (55.3%) were females, 45 (95.7%) were White, and 13 (27.7%) patients received IV-tPA. Aspiration thrombectomy was performed in 31 (65.9%) patients and a Stent retriever (SR) was used in 11 (34.1%) patients. Peri-procedural complications occurred in 3 (6.4%) patients and symptomatic hemorrhagic transformation (sICH) was seen in 6 (12.8%) patients. Regarding 90-day outcomes, 8 (17%) patients achieved favorable outcome (mRS 0-2), and the mortality rate was 42.6%. Patients who achieved mRS of 0-2 were all females (100% versus 46.2%, P=0.005), achieved successful recanalization (100% versus 87.2%, P=0.284) and were more likely to have received IV tPA (62.5% versus 20.5%, P=0.016). On multivariable analysis, only admission National Institutes of Health stroke scale (NIHSS) on admission was independently associated with favorable outcome (OR 0.801, 95% CI 0.642-0.999, P=0.049). Conclusion About one in five patients presenting with extreme large infarction core (ASPECTS 0-2) may achieve a favorable 90-day functional outcome following MT. However, MT in this group of patients was associated with high mortality and sICH rate. Disclosures E. Almallouhi: None. M. Anadani: None. S. Samir Elawady: None. M. Mahdi Sowlat: None. I. Maier: None. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M Starke: None. M. Psychogios: None. E. Samaniego: None. A. Arthur: None. S. Yoshimura: None. J. A. Grossberg: None. A. Alawieh: None. J. Mascitelli: None. I. Fragata: None. H. Cuellar: None. A. Polifka: None. J. Osbun: None. R. Crosa: None. C. Matouk: None. M. S. Park: None. M. R. Levitt: None. W. Brinjikji: None. T. Dumont: None. R. Williamson Jr.: None. P. Navia: None. A. M Spiotta: None. S. Al Kasab: None.
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