Purpose With thrombectomy for anterior circulation large vessel occlusion (ACLVO) stroke, time to recanalization is considered important, but collateral status may be a greater driver of outcome than time. We tested the hypothesis that patients with ACLVO stroke who present with a small core infarct on DWI would show similar good outcomes after thrombectomy, regardless of time from onset.

Materials and methods A cohort of 49 patients treated with thrombectomy after MR selection for ACLVO stroke from 11/1/2012 until 5/15/2015 was retrospectively reviewed. Patients were selected for thrombectomy based on DWI screening with presentation core volume ≤100 age considered favorable. Patients were divided into early (n = 24) or extended (n = 25) treatment groups, with intention to treat ≤6 hours = early, and comparisons made with final infarct volume the primary outcome.

Results Baseline characteristics were similar (early versus extended), including admission NIHSSS (IQR 13–19 versus 11–18). Recanalization ≥ TICI2B was 79% and 83% respectively. There was no significant difference in median final infarct volume (16 mL versus 22 mL, estimated difference +4 mL [95 CI: –13 – +19], p = 0.61) or median infarct growth (1 mL versus 5 mL, estimated difference 1.0 mL [95 CI: –7.0 – +10], p = 0.71). For decision to treat up to 20 hours after onset, time did not correlate with final infarct volume, Figure 1. Similar rates of complications and mortality were observed.

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Abstract P005 Figure 1

Final core volume does not correlate with treatment decision time. Dashed line, t = 6 hours; open circle = successful recanalization, closed circle = failed recanalization; Spearman rank-order correlation, r_s(46) = 0.085, p = 0.566

Conclusion Using MR selection, similar good outcomes after thrombectomy for ACLVO stroke may be achieved well beyond 6 hours.

Disclosures B. Cristiano: None. M. Pond: None. S. Basu: None. U. Oyoyo: None. J. Jacobson: 4; C; GeneLux.