Abstract 53: Patients With Tandem Lesions Undergoing Thrombectomy Have Increased In-Hospital Stroke Recurrence Risk

Abstract

Introduction: Mechanical Thrombectomy improves outcomes in patients with acute ischemic stroke due to large vessel occlusion. Nearly 15% of patients have a tandem extracranial and intracranial occlusion. There is limited data on in-hospital outcomes in patients with acute tandem lesions undergoing thrombectomy. Methods: We included patients hospitalized with acute ischemic stroke and large vessel occlusion undergoing thrombectomy at our comprehensive stroke center over a 7-year period. Data on demographics and baseline risk factors, occlusion site, and acute treatment was pulled from the stroke registry. Records were reviewed for the study outcome which was recurrent ischemic stroke during the in-hospital period, defined as new or worsening neurological symptoms due to new infarct or extension of the infarct. All outcomes were confirmed by a second neurologist. Patients were followed for 90-days and received a 90-day call to determine their modified rankin scale. We defined good functional outcome as 90-day mRS 0-2. We used fisher’s exact test and t-tests to compare categorical and continuous variables and built binary logistic regression model to compare 90-day mRS across the two groups (tandem vs. non-tandem lesions), adjusting for age and NIHSS scale. Results: We identified a total of 1347 patients (mean age 72 years, 51% women) who underwent thrombectomy and 226 (16.7%) had tandem lesions and 108/226 (47.8%) underwent acute stenting. Patients with tandem lesions were more likely to be men (60.6% vs. 46.6%,), have hyperlipidemia (60.9% vs. 52.1%), coronary artery disease (25.3% vs. 19.0%), smokers (35.9% vs. 20.5%) and less likely to have atrial fibrillation (20.0% vs. 46.2%) and history of congestive heart failure (8.0% vs. 16.8%), all p<0.05. Patients tandem occlusions were more likely to have in-hospital recurrent ischemic stroke (8.0% vs. 4.1%, p = 0.012). Acute stenting was not associated with improved functional outcome at 90-days (aOR 0.86, 95% CI 0.41-1.82, p = 0.703). Conclusion: In this large cohort of thrombectomy patients, patients with tandem lesions had increased in-hospital recurrent stroke and acute stenting in this sub-group was not associated with improved functional outcome at 90-days.