Abstract TP143: A Retrospective Study Comparing Clinical Outcomes For Thrombectomy-treated Patients With Large Vessel Occlusion Who Met Or Did Not Meet AHA/ASA Eligibility Criteria

Abstract

Introduction: In 2015, the AHA/ASA Stroke Guidelines recommended thrombectomy to treat large vessel occlusions (LVOs) based on multiple clinical trials that demonstrated efficacy and safety. Given the strict eligibility criteria employed by these trials, the guidelines recommended thrombectomy for a limited patient population. However, in real-world settings, patients who do not meet eligibility criteria still undergo thrombectomy at the discretion of their treating physician. The purpose of this study is to compare clinical outcomes and complication rates of thrombectomy patients who do not meet the AHA/ASA criteria to those that do. Methods: Data from patients discharged from October 2017 to February 2021 with LKW <= 6 hours were retrospectively abstracted from electronic medical records. Patients under 18 or with posterior circulation stroke were excluded. Patients were grouped by AHA/ASA criteria for thrombectomy treatment into met (M) vs. not-met (NM). The M group criteria were defined as pre-stroke modified Rankin score (mRS) 0-1, occlusion of the internal carotid artery (ICA) or middle cerebral artery (M1), NIH stroke score (NIHSS) of >=6 on arrival, and ASPECTS>=6. All other patients were categorized as NM. Primary outcomes were 90-day mRS, median change from arrival to 90-day mRS, discharge disposition, and treatment complications. Descriptive analyses were performed using Chi-squared test, Fisher’s exact test, or median test, as appropriate. Results: Among 225 patients who met inclusion criteria, 151 (67.1%) M and 74 (32.9%) NM patients were identified. NM patients had worse mRS scores at 90-days (6.0 [4.29, 6.00] vs. 3.0 [0.00, 6.00]) compared to M patients. However, change from pre-stroke to 90-day mRS was not significant between groups (M: 3.0 [1.00, 5.00] vs NM: 3.0 [1.00, 4.00], p<.846.) No differences were found between M or NM for discharge disposition or treatment complications. Conclusions: While patients in the NM group had worse 90-day mRS scores compared to the M group, the change in mRS scores from pre-stroke to 90-day were the same for both. Results support that thrombectomy treatment of LVOs is safe and effective for both groups. Expansion of AHA/ASA guidelines should be considered.