Abstract WP6: Successful Mechanical Thrombectomy Maybe Associated With Reduced Disability in Patients With Large Core Based on CTP: The Forsaken Cannot be Forgotten

Abstract

Background and Purpose: There is disparity on neuroimaging selection for acute stroke thrombectomy. Patients with large core infarcts are often excluded from reperfusion therapies. We aim to assess rates of favorable clinical outcomes in patients with large cores based on CTP (RAPID) and the effect of collaterals in this population. Methods: Retrospective study of patients with ischemic cores greater than 50cc on CTP and a proximal anterior circulation occlusion on computed tomographic angiogram who underwent endovascular thrombectomy. Evaluation period was October 2015 to June 2018 on three comprehensive stroke centers. Baseline characteristics, ASPECTS and collaterals scores were evaluated. Primary endpoint was rate of favorable clinical outcome at 3 months. Results: 45 patients were included in the study. Mean age was 65 ±14.2 years, mean NIHSS score was 20 (10-32) and mean admission infarct volume was 85±31mL (CBF <30%) and Tmax>6 s was 199.5±68mL. The majority of patients presented within 6 hours (82%). Median ASPECTS score was 8 and 33% of patients had a favorable collaterals. Recanalization thrombolysis in cerebral ischemia 2b-3 was 88%. Post-thrombectomy mean infarct volume at 24 to 48 hours was 107±68.3mL, A total of 42% (19/45) had tPA. A 3-month favorable clinical outcome (mRS 0-2) was present in 31% (14/45) of patients. Rate of intracranial hemorrhage (ph1 or ph2) was 11% (5/45). A total of 92% (13/14) of all patients older than 75 years had a poor clinical outcome (mRS score >2). Among patients with good collaterals 46% (7/15) had good clinical outcomes whereas 23% (7/30) of patients with poor collaterals score had good clinical outcomes at 3 months. The rate of good outcome at three months for patients with ASPECTS> 6 was 31% (11/35), while 41% of patients with both favorable ASPECTS and Collaterals had a good clinical outcome. Hemicraniectomy was performed in 4% (2/45) of all patients. Conclusions: Acute stroke thrombectomy may be beneficial in some patients with large core based on CTP with good collaterals and it should not be withhold solely based on the core infarct volume on CTP in patients presenting within 6 hours.