Abstract TP20: Computed Tomography Perfusion Cerebral Blood Flow < 30% of ≥ 70cc Predicts Poor Functional Outcome in Early Window Endovascular Therapy Despite Favorable ASPECTS Score

Abstract

Introduction: Endovascular Therapy(EVT) has been shown to be efficacious for treatment of large artery occlusion (LAO) acute ischemic stroke (AIS). The 2018 American Heart Association Guidelines for Management of Acute Ischemic Stroke recommend EVT for patients with anterior circulation LAO AIS with ASPECTS ≥6 and groin puncture within 6 hours of symptom onset. CT Perfusion (CTP) pattern with CBF < 30% of ≥ 70cc is a predictor of a large core infarction. Patients within 6 hours of symptom onset with LAO AIS with favorable ASPECTS on non-contrast head CT and large core infarct measurements on CTP may present a decision-making challenge. Hypothesis: CTP CBF < 30% of ≥ 70cc predicts poor functional outcome in anterior circulation LAO AIS with ASPECTS ≥6 with groin puncture for EVT within 6 hours of symptom onset. Methods: From a large healthcare system’s stroke network database, we conducted a retrospective analysis of functional outcomes (90 day mRS) of patients who presented with LAO AIS with ASPECTS ≥6 with CBF < 30% of ≥ 70cc who underwent EVT with groin puncture within 6 hours from symptom onset between July 2016 and March 2018. Results: Over a 21-month period, 12 cases were identified with CBF < 30% ≥ 70cc and ASPECTS ≥ 6 who underwent EVT within 6 hours of symptom onset. Mean and median CBF < 30% were 119.8 cc and 99 cc, while mean and median ASPECTS scores were 9.3 and 10. TICI 3 revascularization was achieved in 6 patients, and TICI 2B was achieved in 3 patients, within one patient each achieving TICI 2A, TICI 1 and TICI 0. Mean and median mRS at discharge were 4.2 and 4, while mean and median 90 day mRS were 4 and 3. Of the five patients who died, none sustained parenchymal type 2 hemorrhages, and two had TICI 2B, two had TICI 3, one had TICI 0 revascularization. Conclusions: In our experience, most patients presenting within 6 hours of symptom onset with a CBF < 30% of ≥ 70cc and an ASPECTS ≥6 achieved poor functional outcomes (mRS of >2) despite overall good rates of revascularization.