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P-021 Should Ischaemic Stroke Patients with Aphasia or High NIHSS Score Undergo Pre-procedural Intubation Prior to Endovascular Treatment?
  1. A Hassan1,
  2. M Adil2,
  3. W Tekle1,
  4. A Qureshi2
  1. 1Neurology, UTSCHSA Valley Baptist, Harlingen, TX
  2. 2University of Minnesota, Minneapolis, MN

Abstract

Background and purpose Presence of aphasia or severe neurological deficits is considered an indication for pre-procedural intubation (PPI) for endovascular treatment (ET) of acute ischaemic stroke (AIS) patients although a critical analysis has not been performed. To compare outcomes in AIS patients undergoing ET with or without PPI in two groups of patients: those with presence of aphasia; and those with admission NIHSS score of ≥20.

Methods All endovascular treated AIS patients were identified through a database maintained from two comprehensive stroke centres over an 8 year period. The rate of intra-procedural intubation in patients without PPI was ascertained. The rates of poor functional outcome at discharge (modified Rankin score [mRS] of ≥3) and intracerebral haemorrhage (ICH) were compared between those who did or did not undergo PPI in the two study groups.

Results In the first analysis, 60 (50%) of 120 patients with aphasia underwent procedure without PPI; 6 of 60 patients required intra-procedural intubation. The odds of any ICH [OR 6.3, 95% CI 1.6–24.0] and in-hospital mortality [OR 9.3, 95% CI 2.7–31.0] were significantly higher among those who underwent PPI after adjusting for potential confounders. In the second analysis, 36 (39%) of 93 patients with NIHSS score ≥20 underwent ET without PPI; 6 of 57 patients required intra-procedural intubation. The risk of any ICH (OR 7.6, 95% CI 0.9–67.8) and in-hospital mortality [OR 5.0, 95% CI 0.9–27.5] were higher among patients who underwent PPI, after adjusting for potential confounders. The rates of good outcome at discharge were significantly lower among those patients with aphasia [OR 0.1, 95% CI 0.04–0.2, p=<0.0001] or those with NIHSS score ≥20 [OR 0.07, 95% CI 0.005–0.9, p=0.04] who underwent PPI.

Conclusions Despite the risk of intra-procedural intubation among patients with either aphasia or admission NIHSS score ≥20 who undergo ET without PPI, the rates of poor outcomes, ICH, and death are prominently lower than those with PPI.

Disclosures A. Hassan: None. M. Adil: None. W. Tekle: None. A. Qureshi: None.

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