Abstract T P17: Futile Revascularization in Patients With Acute Stroke After Treatment With Mechanical Thrombectomy

Abstract

Purpose: Successful revascularization after endovascular treatment may fail to improve outcome in a subset of acute stroke patients. The purpose of this study was to characterize the frequency and predictors of futile revascularization (FR) in patients treated by mechanical thrombectomy with Merci retriever. Methods: We retrospectively analyzed the pooled data of stroke patients from the MERCI and multi MERCI trials. FR was defined as the occurrence of poor outcome (mRS score of ≥3 at 90 days) despite successful revascularization measured by a TIMI score 2 or 3. We evaluated demographic, clinical, angiographic variables and hemorrhage as potential covariates of FR. Variables showing a possible association with FR (p≤0.1) in univariate analysis were considered in multivariate logistic regression modeling. Results: Among 305 patients, 197 patients achieved successful revascularization in the pooled trials. A total of 186 patients were included in the outcome analysis. FR was observed in 98 of 186 (52.7%) patients. Patients with FR were older, increased baseline NIHSS score (21 vs. 16; p<0.0001), increased systolic blood pressure (147.8 vs. 140.0 mmHg; p=0.031), increased glucose levels (147 vs. 120 mg/gL; p=0.0001), more often had a history of hypertension and diabetes mellitus, increased number of attempts to remove clot (3.0 vs. 2.0; p=0.033), longer puncture to revascularization time (1.7 vs. 1.4 hours; p=0.049), decreased rate of TIMI 3 revascularization (52.0% vs. 71.6%; p=0.007), higher rate of symptomatic hemorrhage (10.2% vs. 0%; p=0.002). In the multivariate analysis, independent predictors of FR were NIHSS (OR=1.15; p<0.0001), glucose (OR=1.02; p=0.0008), hypertension (OR=2.62; p=0.012), and TIMI 3 revascularization (OR=3.14; p=0.002). Patients with FR had increased NIHSS score at 24 hours post-procedure (23.2 vs. 6.3) and at discharge (23.7 vs. 3.0), and had longer lengths of hospitalization (11.1 vs. 8.1 days). Conclusion: Futile revascularization is relatively frequent in patients treated by Merci thrombectomy, particularly among those with severe neurological deficits, hyperglycemia or hypertension. These findings may require validation in a larger sample size of mechanical thrombectomy with Merci and stent retrievers.