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  • O-022 General Anesthesia, Baseline ASPECTS, Time to Treatment, and IV TPA Impact Intracranial Hemorrhage after Stentriever Thrombectomy: Pooled Analysis from SWIFT PRIME, SWIFT and STAR Trials

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O-022 General Anesthesia, Baseline ASPECTS, Time to Treatment, and IV TPA Impact Intracranial Hemorrhage after Stentriever Thrombectomy: Pooled Analysis from SWIFT PRIME, SWIFT and STAR Trials
  1. R Raychev1,
  2. J Saver2,
  3. R Jahan3,
  4. R Nogueira4,
  5. M Goyal5,
  6. V Pereira6,
  7. J Gralla7,
  8. E Levy8,
  9. D Yavagal9,
  10. C Cognard10,
  11. D Liebeskind11
  1. 1Saddleback Memorial Medical Center, Laguna Hills, CA
  2. 2Neurology, UCLA Stroke Center, Los Angeles, CA
  3. 3Division of Interventional Neuroradiology, UCLA, Los Angeles, CA
  4. 4Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Department of Neurology, Emory University School of Medicine, Atalanta, GA
  5. 5Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
  6. 6Toronto Western Hospital/University of Toronto, Toronto, ON, Canada
  7. 7Inselspital, University of Bern, Bern, Switzerland
  8. 8Department of Neurosurgery, SUNY at Buffalo, Amherst, NY
  9. 9University of Miami/Jackson Memorial Hospital, Miami, FL
  10. 10Department of Diagnostic and Therapeutic Neuroradiology, University Hospital of Toulouse, Toulouse, France
  11. 11Neurovascular Imaging Research Core, Department of Neurology, UCLA, Los Angeles, California, USA, Los Angeles, CA

Abstract

Introduction Despite the proven benefit of Solitaire for treatment of acute ischemic stroke, symptomatic intracranial hemorrhage (ICH) remains the most feared procedural complication. The aim of this analysis was to identify the factors determining ICH after neurothrombectomy with Solitaire stentriever.

Methods All patients (N = 389) treated with Solitaire in SWIFT, SWIFT PRIME, and STAR trials were analyzed for incidence of 5 different ICH subtypes. Each ICH subtype was correlated with baseline clinical, imaging and procedural characteristic (age, NIHSS, hypertension, diabetes, atrial fibrillation, hyperglycemia, INR, platelet count, ASPECTS, general anesthesia, collateral grade, number of devices passes, final TICI, rescue therapy, IV TPA). Multivariate stepwise logistic regression model was used to identify the predictors of individual ICH subtypes.

Results ICH was observed in 21.6% (N = 84) of which sICH was 1.0% (N = 4), hemorrhage in ischemic territory (HIT) 19.3% (N = 75), PH 5.4% (N = 21), and SAH 2.3% (N = 9). The most significant predictors of any ICH, HIT, and PH are included in Table 1. No specific predictors of SAH, and sICH were identified. Patients who achieved functional independence at 90 days (mRS 0–2) had significantly lower incidence of any ICH, HIT, PH, and no SICH (Table 2).

View this table:
Abstract O-022 Table 1

Predictors of ICH

View this table:
Abstract O-022 Table 2

Clinical outcome

Conclusions Higher baseline ASPECTS, better collaterals and general anesthesia are associated with lower incidence of ICH after neurothrombectomy with Solitaire stentriever. Prolonged time to treatment increases the risk of parenchymal hematoma and hemorrhage in ischemic territory. Parenchymal hematoma is distinctly associated with IV TPA. Of all ICH subtypes, sICH has the strongest impact on functional independence.

Disclosures R. Raychev: None. J. Saver: 2; C; Medtronic, Stryker, Boehrniger, Neuravia. R. Jahan: 1; C; Medtronic. 2; C; Medtronic. R. Nogueira: 2; C; Medtronic, Stryker. M. Goyal: 2; C; Medtronic. V. Pereira: 2; C; Medtronic, Stryker. J. Gralla: 2; C; Medtronic. E. Levy: 2; C; Pulsar, Blockade Medical LLC Medina Medical Inc,. 4; C; Intratech Medical, Ltd Blockade Medical LLC. D. Yavagal: 2; C; Medtronic. C. Cognard: 2; C; Medtronic, Stryker, Microvention. D. Liebeskind: 2; C; Medtronic, Stryker.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/neurintsurg-2016-012589.22

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