Abstract WP43: Successful Reperfusion in Patients With Concomitant Bi-territorial Anterior Circulation Strokes is Associated With Favorable Outcome and Decreased Symptomatic Hemorrhage and Mortality

Abstract

Background and Purpose: Mechanical thrombectomy is now the gold standard treatment for patients presenting with acute ischemic stroke and proximal middle cerebral artery occlusion. The impact of mechanical thrombectomy in patients with concomitant anterior and middle cerebral arteries occlusions has not been evaluated. Methods: We analyzed data collected between January 2012 and june 2018 in a prospective clinical registry of consecutive acute ischemic stroke patients treated with mechanical thrombectomy. Every patient with concomitant anterior and middle cerebral arteries occlusions documented on initial imaging and angiographic first run were included. The primary study outcome was the percentage of patients who achieved a 90-day favorable outcome, defined as an mRS score of 0-2 or equal to the prestroke value. Results: Among 1242 strokes with anterior circulation occlusion treated by thrombectomy, 80 (6.4%) had biterritorial occlusions, defined as ischemic lesions in both anterior and middle cerebral artery territories and occlusions in both territories or carotid occlusion confirmed on first angiographic run. Among them, 67.5% had successful reperfusion of middle cerebral artery defined as mTICI 2B or 3. Patients with successful reperfusion had an increased rate of favorable outcome (28.6% versus 4.2%; P=0.043), decreased risk of symptomatic intracerebral hemorrhage (11.5% versus 45%; P=0.004) and decreased mortality (30.6% versus 66.7%; P=0.006), respectively. Conclusion: In patients with concomitant occlusions of anterior and middle cerebral arteries territories, successful reperfusion is associated with an increased rate of favorable outcome, a decreased risk of symptomatic intracerebral hemorrhage and a decreased mortality.