04:03 PM Abstract No. 167 Safety and efficacy of adjuvant endovascular interventions in refractory anterior circulation thrombectomies

Abstract

Emergent large vessel occlusion (ELVO) due to underlying vessel wall pathology might be refractory to the regular endovascular treatment requiring further intervention to achieve successful recanalization. The aim of our study is to determine the prevalence of refractory thrombectomies requiring further intervention, compare their baseline characteristics and outcomes with patients undergoing regular endovascular treatment, and compare the outcome among different treatment modalities. We retrospectively reviewed 122 consecutive patients treated endovascularly for anterior circulation ELVO from Dec 2015 till May 2018. Refractory thrombectomy was defined as patients requiring intracranial stenting, injection of eptifibatide or suffering re-occlusion in the same artery within one day of the procedure. Baseline characteristics and outcomes were compared between the refractory and regular treatment groups. Outcomes were compared within the refractory group undergoing different treatment modalities with Favorable outcome defined as mRS≤2 after 3 months. Refractory thrombectomies amounted to 15 cases (11.6%). No statistically significant difference between the regular and refractory groups in baseline characteristics, median NIHSS (17 vs. 17, P=0.48), and percentage of favorable outcomes (53.7% vs 60.0%, P=0.75). Patients in the refractory cohort had significantly higher prevalence of multiple risk factors; ≥ 3 risk factors (60% vs 23.3%; P=0.006). Among the vascular risk factors, diabetes and previous stroke/TIA, were the highest predictors of refractoriness with OR 3.884 (1.057-14.270; P=0.041) and 3.600 (1.048-12.367; P=0.042). Within the refractory group, 46.6% were treated by intracranial stenting and 40.0% received Intraarterial eptifibatide injection. There was no significant difference in favorable outcome between patients treated with intracranial stenting vs eptifibatide (57.1% Vs. 33.3%, P=0.57). Refractory thrombectomy is more common in stroke patients with multiple vascular risk factors. Emergent intracranial stenting and eptifibatide injection are equally safe and effective adjuvant treatments in hyperacute strokes with underlying vascular pathology.