Background Obesity has been associated with increased morbidity and mortality in the general population. However, several reports have described lower mortality rates in overweight or obese patients as compared to normal weight ones. Investigations into this phenomenon, commonly described as the obesity paradox, have yielded mixed results thus far. We sought to determine whether clinical outcomes differ between patients with acute ischemic stroke after endovascular therapy according to their body mass index (BMI).

Methods We reviewed our prospectively collected endovascular database at a tertiary care academic institution. All patients that underwent endovascular therapy for acute large vessel occlusion acute ischemic stroke were categorized according to their BMI into four groups (1) underweight (BMI <18.5), (2) normal weight (BMI=18.5–25), (3) overweight (BMI=25–30) and (4) obese (BMI >30). Baseline characteristics, procedural radiological as well as outcome parameters were compared.

Results 926 patients qualified for the study, of which 20 (2.2%) were underweight, 253 (27.3%) had a normal weight, 315 (34%) were overweight and 338 (36.5%) obese. When compared with normal weight (reference) overweight patients had higher rates of dyslipidemia, as well as diabetes, higher baseline glycemic and HbA1c levels. Conversely, obese patients were younger, less often smokers, and had higher rates of hypertension, as well as diabetes and higher baseline glycemic and HbA1c levels. Procedural characteristics including baseline NIHSS and ASPECT scores were comparable between groups. In terms of outcomes, rates of successful reperfusion (mTICI 2b-3), parenchymal hematomas, 90 Day good clinical outcomes (modified Rankin scale, mRS 0–2) and 90 day mortality were comparable between BMI groups. On multivariate analysis, BMI was not associated with good outcomes nor mortality whether as a continuous variables or a categorical variable.

Conclusions In stroke patients treated with mechanical thrombectomy, BMI does not significantly impact outcomes. However, patients who are overweight or obese have more co-morbidities which should be individually addressed.

Disclosures J. Grossberg: 1; C; Georgia Research Alliance. 4; C; NTI. M. Bouslama: None. D. Haussen: None. M. Frankel: None. R. Nogueira: None.