Abstract TP26: Benefit of Endovascular Therapy Across Clinical Trial Design and Technique: A Single Center Pooled Analysis

Abstract

Introduction: Endovascular therapy practice has evolved dramatically over the last decade. Various randomized trials have investigated the benefit of thrombectomy using different selection criteria including patient populations based on time of presentation, imaging criteria, and procedural technique. We sought to understand the benefit of thrombectomy in patients treated within the context of a clinical trial regardless of trial design at a single academic center. Methods: Data were analyzed from patients enrolled in randomized controlled trials investigating the benefit of endovascular thrombectomy over medical management (IMSIII, ESCAPE, SWIFT PRIME and DAWN) between 2007 and 2017 at a single academic referral center. Results: A total of 130 patients (intervention group, n=80; medical group, n=50) were identified across four clinical trials (IMSIII, n=46; ESCAPE, n=24; SWIFT PRIME, n=14; DAWN, n=46). There were no significant differences between the treatment arm and control arm in terms of age, gender, baseline NIHSS, baseline ASPECTS and occlusion location. There were no differences in rates of sICH, PH-2 or mortality. Rates of good outcome were superior in the intervention group with early neurological recovery (defined as NIHSS of 0-1 or drop in NIHSS of 8 points at 24 hours) at a higher rate of 53% vs 14% (p=<0.001) and higher rates of functional independence (90 day mRS 0-2 of 54% vs 26%, p=0.002). In multivariate logistic regression analysis, lower NIHSS and younger age were predictors of good outcome. There were comparable rates of good outcome irrespective of clinical trial, imaging selection criteria (CTP vs MRI), early versus late time window design (0-6 hours vs 6-24 hours) and procedural technique (Merci vs Solitaire/Trevo). Conclusions: At a large academic center, the benefit of endovascular therapy over medical therapy is observed irrespective of clinical trial design, patient selection or procedural technique.