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SNIS 20th annual meeting electronic poster abstracts
E-224 Outcomes of mechanical thrombectomyin stroke patients with extreme large infarction core
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  1. E Almallouhi1,
  2. M Anadani1,
  3. S Samir Elawady1,
  4. M Mahdi Sowlat1,
  5. I Maier2,
  6. P Jabbour3,
  7. J Kim4,
  8. S Quintero Wolfe5,
  9. A Rai6,
  10. RM Starke7,
  11. M Psychogios8,
  12. E Samaniego9,
  13. A Arthur10,
  14. S Yoshimura11,
  15. JA Grossberg12,
  16. A Alawieh12,
  17. J Mascitelli13,
  18. I Fragata14,
  19. H Cuellar15,
  20. A Polifka16,
  21. J Osbun17,
  22. R Crosa18,
  23. C Matouk19,
  24. MS Park20,
  25. MR Levitt21,
  26. W Brinjikji22,
  27. T Dumont23,
  28. R Williamson24,
  29. P Navia25,
  30. AM Spiotta1,
  31. S Al Kasab1
  1. 1Division of Neuroendovascular Surgery, Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
  2. 2University Medicine Goettingen, Göttingen, Germany
  3. 3Thomas Jefferson University, Philadelphia, PA, USA
  4. 4Chonnam National University Hospital, Gwangju, Korea, Republic of
  5. 5Wake Forest Baptist Health, NC, NY, USA
  6. 6West Virginia University, Morgantown, WV, USA
  7. 7University of Miami Health System, Miami, FL, USA
  8. 8Universitätsspital Basel, Basel, Switzerland
  9. 9University of Iowa, Iowa, IA, USA
  10. 10University of Tennessee Health Science Center/Semmes Murphey Foundation, Memphis, TN, USA
  11. 11Hyogo College of Medicine, Hyogo, Japan
  12. 12Emory University, Atlanta, GA, USA
  13. 13University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
  14. 14Centro Hospitalar Universitário de Lisboa Central, Lisboa, Portugal
  15. 15LSU Health Shreveport, Shreveport, LA, USA
  16. 16University of Florida, Gainesville, FL, USA
  17. 17Washington University in St. Louis, St. Louis, MO, USA
  18. 18Médica Uruguaya, Departamento de Montevideo, Uruguay
  19. 19Yale University, New Haven, CT, USA
  20. 20University of Washington, Charlottesville, VA, USA
  21. 21University of Washington, Seattle, WA, USA
  22. 22Mayo Clinic, Rochester, MN, USA
  23. 23University of Arizona, Tucson, AZ, USA
  24. 24Alleghany Hospital, Sparta, NC, USA
  25. 25Hospital Universitario La Paz, Madrid, Spain

Abstract

Introduction Recent clinical trials have demonstrated that patients with large vessel occlusion (LVO) and large infarction core may still benefit from mechanical thrombectomy (MT). However, limited data is available about the outcomes of MT in LVO patients presenting with extreme large infarction core (Alberta Stroke Program Early CT Score (ASPECTS) of 0-2).

Methods Data from Stroke Thrombectomy and Aneurysm Registry (STAR), which combined the prospectively maintained databases of 84 thrombectomy-capable stroke centers in the US, Europe, and Asia, was interrogated. We identified thrombectomy patients presenting with an occlusion in the intracranial internal carotid artery (ICA) or M1 segment of the middle cerebral artery (MCA) and extreme large infarction core (ASPECTS 0-2). Patients with tandem occlusion were excluded from these analyses. Favorable outcome was defined by achieving achieved modified Rankin scale (mRS) of 0-2 at 90 days post-MT. Successful recanalization was defined by achieving a Modified Thrombolysis in Cerebral Infarction (mTICI) score of ≥2B.

Results We identified 47 patients who presented with ASPECTS 0-2 and underwent MT (24 had M1 occlusion and 23 had intracranial ICA occlusion). The average age was 69.4; 26 (55.3%) were females, 45 (95.7%) were White, and 13 (27.7%) patients received IV-tPA. Aspiration thrombectomy was performed in 31 (65.9%) patients and a Stent retriever (SR) was used in 11 (34.1%) patients. Peri-procedural complications occurred in 3 (6.4%) patients and symptomatic hemorrhagic transformation (sICH) was seen in 6 (12.8%) patients. Regarding 90-day outcomes, 8 (17%) patients achieved favorable outcome (mRS 0-2), and the mortality rate was 42.6%. Patients who achieved mRS of 0-2 were all females (100% versus 46.2%, P=0.005), achieved successful recanalization (100% versus 87.2%, P=0.284) and were more likely to have received IV tPA (62.5% versus 20.5%, P=0.016). On multivariable analysis, only admission National Institutes of Health stroke scale (NIHSS) on admission was independently associated with favorable outcome (OR 0.801, 95% CI 0.642-0.999, P=0.049).

Conclusion About one in five patients presenting with extreme large infarction core (ASPECTS 0-2) may achieve a favorable 90-day functional outcome following MT. However, MT in this group of patients was associated with high mortality and sICH rate.

Disclosures E. Almallouhi: None. M. Anadani: None. S. Samir Elawady: None. M. Mahdi Sowlat: None. I. Maier: None. P. Jabbour: None. J. Kim: None. S. Quintero Wolfe: None. A. Rai: None. R. M Starke: None. M. Psychogios: None. E. Samaniego: None. A. Arthur: None. S. Yoshimura: None. J. A. Grossberg: None. A. Alawieh: None. J. Mascitelli: None. I. Fragata: None. H. Cuellar: None. A. Polifka: None. J. Osbun: None. R. Crosa: None. C. Matouk: None. M. S. Park: None. M. R. Levitt: None. W. Brinjikji: None. T. Dumont: None. R. Williamson Jr.: None. P. Navia: None. A. M Spiotta: None. S. Al Kasab: None.

https://doi.org/10.1136/jnis-2023-SNIS.323

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