Purpose It is well established that endovascular thrombectomy (EVT) benefits patients with acute ischemic stroke (AIS). Nevertheless, although ~30% of patients with large infarct volume regain functional independence at 90 days, it remains controversial whether this particular cohort should be treated. The purpose of this study was to determine predictors of functional independence in a large infarct AIS patient cohort treated with EVT.
Materials and methods Patients treated with the Penumbra System were pooled from five, multicenter trials (PIVOTAL, PICS, RetroSTART, START, Separator 3D). Of the 957 pooled AIS patients, data from 614 met study criteria and were subjected to multivariate analyses to identify factors which predict functional independence (90 day mRS 0–2) in the Penumbra System ASPECTS 0–6 cohort. These data were subsequently compared to an ASPECTS 0–6 natural history cohort.
Results The rate of 90 day functional independence was 27.1% and 7.9% in the EVT ASPECTS 0–6 cohort compared to the natural history cohort, respectively (p=0.0002). Amongst the ASPECTS 0–6 EVT patients, the mortality rate was 34.8% compared to 23.6% in the ASPECTS 0–6 natural history cohort (p=0.084). The rate of symptomatic intracranial hemorrhage (sICH) was 14.2% in the ASPECTS 0–6 EVT patient population compared to 3.4% in the ASPECTS 0–6 natural history cohort (p=0.0077). Among the ASPECTS 0–6 patient population treated with mechanical thrombectomy, age (p=0.0048) and NIHSS at admission (p=0.0198) were significantly associated with functional independence at 90 days. The results of these analyses are depicted in Tables 1 and 2.
Conclusions The present analysis indicates that large infarct volume patients who present with predictors of 90 day functional independence should be considered for endovascular treatment. These results have significant implications for the decision to treat in this AIS stroke cohort.
Disclosures D. Frei: 2; C; Penumbra, Inc.. 4; C; Penumbra, Inc.. R. Nogueira: None. A. Siddiqui: 6; C; Penumbra, Inc. J. Wagner: 3; C; Genentech. 6; C; Penumbra, Inc.. O. Zaidat: None. A. Yoo: 1; C; Penumbra, Inc.. 2; C; Neuravi.
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