Abstract TP188: Diving MCA and First-Pass Reperfusion: A Subgroup Analysis of the Arise II Study

Abstract

Introduction: Tortuosity of Internal carotid artery impact on achieving first pass in mechanical thrombectomy has been previously described. Here, we investigate the association of middle cerebral artery(MCA) tortuosity on radiographic and functional outcome. Methods: The Analysis of Revascularization in Ischemic Stroke with EmboTrap II was utilized to identify patients with anterior circulation stroke. MCA tortuosity was calculated using Inflection Count Metric(ICM) by two blinded readers to angiographical/clinical outcomes. The total cohort was trichotomized into 3 groups (A, B, C) based on M1 tortuosity tertiles. The primary efficacy end point was achievement of modified Thrombolysis in Cerebral Ischemia (mTICI) reperfusion scores of ≥2b on first pass. Good functional outcomes was defined as mRS0-2 on 90-day followup. Baseline and procedural data were compared between groups. Results: A total of 200 with known MCA tortuosity were identified. Patients within group A were significantly older (P<0.05) . Group C patient were more likely to have renal disease and atrial fibrillation (P<0.05). There was no differences in terms of NIHSS score at presentation nor ASPECT score between groups. Achieving first-pass success was more likely in group A (60.6%) vs 47% and 38.2%, P=0.033 for groups B and C, respectively. Likewise, the rate of mTICI≥2c was higher in group A (54.5%) vs 36.4% and 26.5%, p=0.003. Achieving mRS0-2 was more likely in group A (76.6%) vs 73.4% and 49.3%, p=0.001. There were no differences in distal emboli, or symptomatic intracranial hemorrhage. Findings of first-pass and angiographic outcomes were consistent with standard tortuosity scoring system. Conclusion: Patients with higher MCA tortuosity are less likely to have successful reperfusion and good functional outcome post mechanical thrombectomy for acute ischemic stroke.