Abstract WP67: Selecting Stroke Patients for Late Thrombectomy Using non-RAPID Software: A Real-world Experience

Abstract

Background: Clinical trials have determined the superiority of late thrombectomy for acute ischemic stroke (AIS) patients if selected based on pretreatment images postprocessed using RAPID software. However, RAPID software is not accessible in many regions. Objective: To evaluate the performance of a widely accessible imaging postprocessing software in selecting AIS patients for late thrombectomy, and compare the outcomes with those of the DAWN trial. Methods: This study was based on a prospective registry study in a high-volume stroke center. AIS patients who presented later than 6 hours after the time last known well (TLKW) underwent multimodal CT, and all images were postprocessed using conventional software (Siemens Healthcare). All images were visually inspected by experienced doctors who determined whether patients were eligible for thrombectomy. The primary outcome was the proportion of functional independence (i.e., mRS score 0 to 2) at 90 days. Results: A total of 27 consecutive AIS patients (aged 60.6±12.7 years) were recruited in this study. The median interval between TLKW to groin puncture was 9.5 hours, baseline NIHSS score was 15.7±8.1, the median ASPECT score was 8. After endovascular procedures, 23 patients (85%) achieved substantial recanalization (mTICI≥2b). Twelve patients (44%) experienced early therapeutic response, whereas 3 patients (8%) suffered from neurological deterioration, and 2 patients (7%) experienced symptomatic intracranial hemorrhage. At 3-month follow up, 14 patients (52%) achieved functional independence and 3 patients (11%) died. There were no significant differences between the DAWN trial and this study with respect to the above outcomes (Figure, p>0.05 each). Conclusions: In a high-volume stroke center, it would be practical to select AIS patients for late thrombectomy based on pretreatment multimodal CT images postprocessed without RAPID software, with clinical outcomes similar to those of the DAWN trial.