Abstract WMP5: Predictors and Outcome of Eligible Patients for Late Endovascular Treatment: Real Life Analysis From a Comprehensive Stroke Center

Abstract

Background and Aims: The DAWN and DEFUSE-3 trials demonstrated the benefit of late endovascular treatment (EVT) in acute ischemic stroke (AIS) patients. We aimed to identify indipendent predictors for late EVT eligibility according to trials and to more liberal criteria. Moreover, we compared the clinical outcome of patients treated with late EVT and fulfilling each set of selection criteria. Material and Methods: In the ASTRAL registry (2003-2017), we calculated the proportion of late (6-24 hours) EVT eligibility according to trials and to more liberal criteria (the latter including M2 occlusion, lower NIHSS on admission, and using ASPECTS for core volume estimation). We searched for clinical and radiological variables associated with late EVT eligibility using a multivariate regression. We also analysed functional independence (modified Rankin Scale (mRS) 0-2) at 3 months for patients treated with late EVT. Results: Out of 925 late arriving AIS patients with complete data, 2.5% were eligible with DAWN, 5.1% with DEFUSE-3 and 11.1% with liberal criteria. Variables associated with late EVT eligibility are shown in Table 1. Functional independence was achieved in 6/14 (42.9%) of the trial-eligible, and in 11/27 (40.7%) of the liberal-eligible patients treated with EVT. After adjustment for age, NIHSS, vigilance impairment, ASPECTS and acute glucose, DEFUSE-3-like patients showed better outcome than DAWN-like and liberal criteria selected patients (OR 4.45; 95%CI 1.11-17.85). Conclusion: Among late arriving AIS patients, only 5% were eligible for late EVT based on trials criteria. Radiological variables were stronger than clinical predictors to identify DAWN and DEFUSE-3 patients. In the small cohort of effectively treated patients, satisfying DEFUSE-3 was associated with the most favourable outcome.