Abstract TP149: Pretreatment Parameters Predicting Excellent Recanalization of Large Vessel Occlusion in Patients With Acute Ischemic Stroke

Abstract

Introduction: In large vessel occlusion (LVO) ischemic stroke patients, better functional outcomes are associated with achieving modified thrombolysis in cerebral infarction (mTICI) score 2C/3 in comparison to 2B. The purpose of this study was to identify pretreatment and interventional predictors of mTICI 2C/3 over 2B reperfusion in patients with LVOs treated successfully with thrombectomy. Methods: Data from two comprehensive stroke centers between 2019-2023 were retrospectively reviewed for LVO acute ischemic stroke patients treated successfully (mTICI 2B/2C/3) with thrombectomy. Primary outcome measure was achieving mTICI 2C/3 (i.e., excellent) revascularization. Demographic variables, CT perfusion parameters, and intervention-related parameters were evaluated as univariate regressors of primary outcome. Significant univariate predictors were included in a forward stepwise multivariate logistic regression, and adjusted odds ratios (aOR) were reported. Results: Of 149 patients, the median age was 70 years old (IQR: 65-78.5), and 57.7% were female. Multivariate logistic regression analyses (AUC = 0.79, 95% CI: 0.68-0.86, p<0.001) showed that patients had a higher likelihood of excellent recanalization with lower admission NIHSS (aOR 0.93, p = 0.036), no history of diabetes mellitus (DM) (aOR 0.42, p = 0.050), no prior stroke (aOR 0.27, p = 0.007), cerebral blood volume (CBV) index >= 0.7 (aOR 3.75, p = 0.007), and thrombectomy with aspiration alone (aOR 2.89, p = 0.012). Conclusions: Robust collateral status (as represented by CBV index), absence of diabetes mellitus, no prior stroke history, lower initial stroke severity, and aspiration thrombectomy were associated with increased likelihood of excellent recanalization amongst technically successfully revascularized LVO stroke patients. Preventative comorbidity management, collateral status on imaging, and thrombectomy technique may optimize chances for excellent recanalization.