Abstract Number ‐ 167: Predictors of Incomplete Recanalization in Mechanical Thrombectomy

Abstract

Introduction Endovascular mechanical thrombectomy (MT) is a highly effective treatment for acute ischemic stroke (AIS) patients due to large vessel occlusion. Although many of these patients achieve successful recanalization, there remains a proportion of patients who fail to recanalize. Incomplete recanalization (defined as TICI 0–2a) has been associated with poor functional outcome; however, risk factors that may predispose these patients to incomplete recanalization remain unclear. We aimed to evaluate various demographic and procedural variables as predictors of incomplete recanalization. Methods AIS patients from 2019–2022 at our institution were reviewed. All patients who received MT for treatment were identified. Demographic characteristics including comorbidities, medications, thrombolytic use, ASPECTS, hematologic markers as well as procedural data including TICI score, time to clot, technique, occlusion location, and number of passes was assessed. Results One‐hundred eighty‐two patients received MT. Forty‐one patients had incomplete recanalization. History of tobacco use (aOR = 57.8, 95% CI = 5.75—581.2) and no history of HMG‐CoA reductase inhibitor use prior to hospital admission (aOR = 20.9, 95% CI = 1.58—277.1) were found to be predictors of incomplete recanalization. Baseline ASPECTS score, multiple passes with stent retriever, sex, LDL, and hematocrit count were also included in the multivariate analysis due to univariate association (p< 0.10) with the primary outcome. Conclusions A history of tobacco use may indicate a predisposition to difficulty in recanalizing a large‐vessel occlusion with MT. These results may also indicate a protective mechanism of HMG‐CoA reductase inhibitor use in these patients that increases the likelihood of recanalization. While successful recanalization in AIS patients due to large‐vessel occlusion has been well established in recent years to predict improved functional outcome, further investigations evaluating the characteristics of those AIS patients who are unable to be recanalized with MT are warranted.