Abstract TP25: Outcomes of Endovascular Thrombectomy in Late-presenting Patients: Findings From the Florida Stroke Registry

Abstract

Introduction: It is unclear whether the outcomes of late presenting patients (6-24 hrs from symptom onset) receiving endovascular thrombectomy (EVT) in routine clinical practice parallels the favorable results of recently completed randomized trials. We evaluated characteristics and outcomes of EVT utilization, over the past decade, for late and early presenting (≤ 6 hrs from onset) patients. Methods: From Jan 2010 to Jan 2019, 84,346 ischemic stroke patients presenting within 24 hrs of symptoms were enrolled in the Florida Stroke Registry. Differences in clinical characteristics, utilization trends and outcomes at discharge were compared between late vs. early presenting EVT patients using multivariable regression analysis. Results: Among 5,702 EVT patients (mean age 71±15, 48% women), 1,580 (28%) were late presenting. Late presenting EVT patients had higher rates of private insurance (39% vs 35%), dyslipidemia (39% vs 35%) and smoking (16% vs.13% ) but lower rates of Hispanic patients (19% vs 24%) and atrial fibrillation (34% vs 37%.). Late presenting patients had lower National Institute of Health Stroke Scores [median 14 (IQR=12) vs 17 (IQR=11)] and rates of thrombolysis (6% vs 58%). Short term discharge outcomes and treatment complications are shown in Table. In multivariable analysis adjusting for age, sex, stroke severity and intravenous thrombolysis, late presenting EVT patients had similar symptomatic intracerebral hemorrhage rates [OR 1.02 (0.72-1.45)] and outcomes but were less likely to ambulate independently at discharge (OR 0.80, 95% CI 0.70-0.92) compared to early presenting EVT patients. Discussion: Over the past decade, nearly a third of EVT patients were treated after 6 hours from onset. In clinical practice late EVT carries comparable safety and favorable outcome profiles to early EVT.