Abstract WP204: Impact of Reperfusion Grade and First Pass Effect in Large vs Small Core Patients Undergoing Mechanical Thrombectomy

Abstract

Introduction: While patients with small core stroke (SCS) and large core stroke(LCS) benefit from Mechanical Thrombectomy(MT), the impact of reperfusion (Thrombolysis in Cerebral Infarction (eTICI) grade and the first pass effect (FPE)) on clinical outcomes remains poorly understood. We aim to study the interplay between these factors in LCS and SCS patients. Methodology: Retrospective analysis of a comprehensive stroke center prospective database for patients with MCA-M1 or ICA-T occlusions who underwent MT between November 2010-March 2023. Logistic regression models assessed ASPECTS and eTICI score relationships and their impact on outcomes, adjusted for age, NIHSS, tPA, hypertension, general anesthesia and clot location. Results: Of 1548 included patients (mean age 65±16 years, 50.0% males)Table 1, 9.1%(141/1548) were categorized as a LCS (ASPECTS 0-5: 3.5% ASPECTS 0-2 and 96.0% 3-5) while 90.9%(1407/1548) as a SMC (53.0% ASPECTS 6-8 and 47.0% ASPECTS 9-10)(Table1). Lower rates of FPE were achieved in the LCS cohort (26%) compared to the SCS cohort (36%). First pass effect had comparable relative impact on independence rates on LCS and SCS (Figure1A; p>0.05). Final reperfusion rates were comparable LCS and SCS cohorts; In LCS, 5%, 11%, 26%, and 49% achieved eTICI grades 0-2a, 2b50, 2b67, and 2c-3, while in SCS, the percentages were 5.3%, 11%, 18%, and 66%. The relative benefit of final eTICI2c-3 vs 2b50 was comparable between LCS and SCS (p>0.05;Figure1B) Conclusion: The magnitude of benefit of achieving FPE as well as final full reperfusion (eTICI2c-3 vs eTICI2b) is comparable in large and smaller core strokes.