Abstract TP34: Technical Considerations in Achieving Optimal Patient Outcomes in Thrombectomy for Acute Ischemic Stroke

Abstract

Introduction: Thrombectomy for acute ischemic stroke with large vessel occlusion is a highly effective therapy. However, meta-analyses of seminal trials show as many as 54% of thrombectomy patients do not achieve functional independence at 90 days (Goyal et al, Lancet 2016) and 72% of patients do not get discharged to home (Jahan et al, NEJM 2019). Here we investigate technical factors associated with maximizing the likelihood of good discharge outcome. Specifically, we evaluated how thrombectomy technique (clot suction alone, stentretriever alone, or combination therapy with both) and reperfusion grade (partial TICI 2b or complete TICI 3) affected the likelihood of good outcome defined as discharge to home or acute rehab. Methods: Retrospective data from 15 hospitals were used including patients age 18 or over discharged from January 2014 to May 2019 with a primary or secondary diagnosis of ischemic stroke who received a thrombectomy and achieved TICI reperfusion grade of 2b or 3. Primary outcome was discharge to home or inpatient rehabilitation (IRF) versus other discharge dispositions, including death. Multivariate logistic regression was used to determine if TICI 3 versus TICI 2b and/or procedure technique (retrievable stent only, distal aspiration only or a combination approach with both) were associated with better outcome of discharge to home/IRF, adjusting for age, race, medical history, and NIHSS at admission. Main effects and interaction between technique and TICI were included in the model. Results: The analysis included 787 patients, 55.3% (n=435) were discharged home/IRF and 44.7% (n=352) were discharged elsewhere or expired. Patients with TICI 3 grade were more likely to be discharged to home/IRF compared to those with TICI 2b (Adjusted Odds Ratio (AOR)=1.35, p=.018). Those who received distal aspiration only (AOR=1.87. p<.001) and combination approach (AOR=1.64, p=.047) were also more likely to have favorable discharge status compared to stent retriever only. The interaction effect of TICI score and procedure technique was not significant (p=.873). Conclusion: Our analysis suggested that both TICI grade 3 and distal aspiration or combination approach techniques independently predicted more favorable disposition outcome.