Abstract P475: Intravenous Alteplase and Successful Recanalization Predict Good Outcome in Patients With M3 Segment Occlusions Undergoing Thrombectomy

Abstract

Introduction: Advancements in the technology and techniques of clot removal has resulted in more distal clots becoming accessible for mechanical thrombectomy. The goal of this study was to assess the predictors of good outcome in stroke patients who underwent mechanical thrombectomy (MT) of the M3 segment of the middle cerebral artery. Methods: We performed a post-hoc analysis data from the North American Solitaire Stent Retriever Acute Stroke (NASA) and Trevo Stent-Retriever Acute Stroke (TRACK) registries. We included patients with middle cerebral artery occlusion of the M3 segment treated with MT within 24 hours of last normal. The primary outcome was 90-day modified Rankin Scale of 0-2, which we termed good outcome. We fit logistic regression models and adjusted for variables selected with backwards stepwise selection set to p<0.05. Results: We included 131 patients; mean age 69.5, 43.5% male, and 13/131 (9.9%) had symptomatic intracranial hemorrhage. At 90 days, 66 patients (50.4%) had good outcome. The most predictive variable for good outcome was successful recanalization (103/131), which had an adjusted odds ratio (aOR) of 18.78 (95% confidence interval (CI) 4.07-86.7; p= <0.001). Intravenous alteplase was also associated with good outcome (aOR 3.13; 95% 1.20-8.12; p = 0.0019). Higher baseline mRS and NIHSS were associated with a decreased probability of good outcome, aOR= 0.39 (95% CI 0.22- 0.72; p = 0.002) and aOR = 0.89 (95% CI 0.82- 0.97; p = 0.006). Rescue endovascular therapy was also associated with a decreased probability of good outcome aOR 0.17; (95% CI 0.05-0.66; p = 0.010). Conclusion: Patients undergoing MT of the M3 segment were more likely to achieve good outcome if successfully recanalized or intravenous alteplase was administered prior to thrombectomy. Rescue treatments were associated with a lower likelihood of good outcome.