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E-105 Predictors of excellent outcomes post thrombectomy in large vessel occlusion with mild strokes
  1. A Pandhi1,
  2. N Goyal1,
  3. G Tsivgoulis1,
  4. K Malhotra2,
  5. M Ishfaq1,
  6. M Frohler3,
  7. A Spiotta4,
  8. M Anadani4,
  9. M Psychogios5,
  10. V Maus5,
  11. A Siddiqui6,
  12. M Waqas6,
  13. P Schellinger7,
  14. M Groen7,
  15. O Saeed1,
  16. C Krogias8,
  17. D Richter8,
  18. M Saqqur9,
  19. P Bermejo9,
  20. M Mokin10,
  21. R Leker11,
  22. A Katsanos12,
  23. G Magoufis13,
  24. K Psychogios13,
  25. V Lioutas14,
  26. M VanNostrand14,
  27. V Sharma15,
  28. M Paciaroni16,
  29. A Rentzos17,
  30. H Shoirah18,
  31. J Mocco18,
  32. D Hoit19,
  33. L Elijovich19,
  34. A Alexandrov1,
  35. A Arthur19
  1. 1Neurology, UTHSC, Memphis, TN
  2. 2Neurology, West Virginia University, Morgantown, WV
  3. 3Cerebrovascular, Vanderbilt University, Nashville, TN
  4. 4Neurosurgery, Medical University of South Carolina, Charleston, SC
  5. 5Neuroradiology, University Medical Center Göttingen, Gottingen, Germany
  6. 6Neurosurgery and Radiology, University of Buffalo, Buffalo, NY
  7. 7Neurology and Neurogeriatry, Johannes Wesling Medical Center Minden, Minden, Germany
  8. 8Neurology, St. Josef-Hospital, Ruhr University of Bochum, Bochum, Germany
  9. 9Neurology, Hammad Medical Center, Doha, Qatar
  10. 10Neurosurgery, University of South Florida, Tampa, FL
  11. 11Neurology, The Agnes Ginges Center of Neurogenetics, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
  12. 12Neurology, National and Kapodistrian University of Athens, ‘Attikon’ University Hospital, Athens, GREECE
  13. 13Acute Stroke Unit, Metropolitan Hospital, Piraeus, Greece
  14. 14Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
  15. 15Neurology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
  16. 16Stroke unit, Divisione di Medicina Cardiovascolare, Università di Perugia, Perugia, Italy
  17. 17Interventional and Diagnostic Neuroradiology, Department of Interventional and diagnostic Neuroradiology, Gothenburg, Sweden, Gothenburg, Sweden
  18. 18Neurosurgery, Mount Sinai Medical Center, New York, New York, NY
  19. 19Neurosurgery, UTHSC and Semmes Murphery Clinic, Memphis, TN


Background As the randomized controlled trials excluded the patients with emergent large vessel occlusion (ELVO) strokes with low NIHSS <6, the efficacy and safety of mechanical thrombectomy (MT) in this cohort is lacking. We sought to explore the predictors of excellent outcomes after MT in this international multicenter study.

Methods Stroke patients with ELVO and NIHSS <6 treated with MT were identified from 16 high volume endovascular stroke centers over a 4 year period (2013–2017). Predictors of excellent outcomes post MT were evaluated. Baseline demographic, clinical and procedural variables were obtained. Successful recanalization was defined as mTICI 2b and 3. Excellent outcomes are defined as modified Rankin Stroke (mRS) scale of 0–1 at 3 months.

Results Total of 146 patients with low NIHSS ELVO were included in the study. Of those, 95 (65%) patients (48% male, 71% Caucasians, mean NIHSS 3.6 ±1.3) had excellent outcome (mRS 0–1), while remaining 51 (35%) patients (57% male, 72% Caucasians, mean NIHSS 3.8 ±1.4) had poor outcome (mRS 2–6). The patients who had excellent outcome had lower age at presentation [years, mean (SD) 61.6±17.2 vs. 68.9±18.6; p: 0.012], higher rates of successful recanalization [91.2% vs. 74%; p: 0.012], and shorter groin puncture to recanalization time [minutes, mean (SD): 43.4 ±27.3 vs. 60.4 ±41.5, p=0.008) compared to poor outcome group. The mean baseline ASPECTS tended to higher in excellent outcome group (9.3 ±1.0 vs. 8.9±1.3, p=0.08). In multivariable analyses after adjustment for potential confounders, lower age (OR: 0.96, 95% CI 0.93–0.99, p=0.034), shorter groin puncture to recanalization time (OR: 0.97, 95% CI 0.96–0.99, p=0.003), and successful recanalization (OR: 11.2, 95% CI 1.5–80.4, p=0.016) were independent predictors of excellent outcome at 3 months.

Conclusions Our retrospective multi-center study demonstrates that lower age, shorter groin puncture to recanalization time and successful recanalization were independent predictors of excellent outcomes post MT in ELVO patients with NIHSS <6.

Disclosures A. Pandhi: None. N. Goyal: None. G. Tsivgoulis: None. K. Malhotra: None. M. Ishfaq: None. M. Frohler: None. A. Spiotta: None. M. Anadani: None. M. Psychogios: None. V. Maus: None. A. Siddiqui: None. M. Waqas: None. P. Schellinger: None. M. Groen: None. O. Saeed:None. C. Krogias: None. D. Richter: None. M. Saqqur: None. P. Bermejo: None. M. Mokin: None. R. Leker: None. A. Katsanos: None. G. Magoufis: None. K. Psychogios: None. V. Lioutas: None. M. VanNostrand: None. V. Sharma: None. M. Paciaroni: None. A. Rentzos: None. H. Shoirah: None. J. Mocco: None. D. Hoit: None. L. Elijovich: None. A. Alexandrov: None. A. Arthur: None.

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