Abstract WP57: Effect of Single Pass Recanalization in Acute Ischemic Stroke With Large Vessel Occlusion: Sub-Analysis of Rescue-Japan Registry 2

Abstract

Introduction: In endovascular treatment (EVT) for acute large vessel occlusion (LVO), multiple passes may promote arterial endothelial injury, potentially reducing clinical efficacy and safety. However, data comparing outcome between single and multiple passes are scarce. Methods: In the Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism (RESCUE)-Japan Registry 2, 2420 patients with acute stroke due to LVO were registered between October 2014 and January 2017. Among them, 1064 patients treated with EVT were analyzed. We classified patients into two groups, a single-pass group and a multiple-pass group, archiving good recanalization (TICI2b-3) in single or multiple passes, and analyzed clinical features and outcomes. Multivariate analyses were performed to determine whether single-pass recanalization was independently associated with improved outcomes and to identify factors associated with needing only a single pass. Results: 592 patients were recanalized by single pass, and 472 patients by multiple passes. Compared with the multiple-pass group, fewer patients in the single-pass group suffered extracranial internal carotid artery occlusion (9.6% vs 14.4%, p=0.014), and more patients suffered M2 occlusion (18.6% vs 14.0%, p=0.045) Onset to recanalization time in the single-pass group was shorter than the multiple-pass group (378.3 minutes vs 397.2 minutes, p=0.00012) Cardiogenic embolic stroke was present in 78.7% and 66.5% of single- and multiple-pass groups (p<0.0001). Modified Rankin scale scores of 0 to 2 at 90 days after onset were observed in 51.5% and 39.0% of patients in the single- and multiple-pass groups (p<0.0001). The adjusted odds ratio (OR) of single pass for a modified Rankin scale score of 0 to 2 at 90 days after onset was 1.59 (95% confidence interval, 1.22-2.06). Intracranial hemorrhage after EVT were observed in 23.3% and 32.6% of patients in the single- and multiple-pass groups (p=0.001). The factors associated with achieving single-pass recanalization was cardiogenic embolic stroke (p=0.00013; OR, 1.75; 95% confidence interval, 1.31-2.33) adjusting for other variables. Conclusion: Achievement of recanalization in a single pass was associated with good clinical outcome.