E-005 primary acute stroke thrombectomy within 3 hours from large artery occlusion (past3-lao) – a pilot study

Abstract

Background In acute ischemic stroke (AIS), 1.9 million cells die each minute. Therefore, an early effective recanalization is necessary to salvage the penumbra and to achieve a good outcome. AIS due to a large artery occlusion (LAO) with high NIHSS (>10), especially in internal carotid artery terminus (ICA-T) are resistant to IV thrombolysis and endovascular thrombectomy is associated with better recanalization rates. Recent randomized controlled trial demonstrated better recanalization rate and outcome in endovascular therapy compared to IV thrombolysis in AIS with LAO. Despite the benefit with endovascular therapy, 68% of patients were either disable or dead. Thrombectomy in AIS with LAO within 3 h (IV t-PA window) is performed as secondary therapy after IV thrombolysis, which is associated with delay in enrollment and recanalization. The delay in recanalization may be responsible for the disproportion between acceptable recanalization and good functional outcomes. The delay in recanalization may be responsible for not achieving a good functional of those who had acceptable recanalization. Objectives To evaluate the feasibility, safety and recanalization rate of primary acute thrombectomy within 3 h in AIS with NIHSS ≥10 from LAO. Additionally, we like to identify the functional outcome. Methods Based on institutionally approved protocol patients with LAO (ICA-T, MCA, vertebral-basilar artery) with LCB within 3 h were offered primary thrombectomy as an alternative to IV rtPA. They were entered into a stroke database. Patients who underwent PAST3 from LAO from 2012 to 2014 were retrospectively analyzed using SAS software. Outcomes were measured using modified Rankin Scale (mRS). Results 18 patients with LAO; mean age 628.3 ± 15.32 years and mean NIHSS 16 ± 4; chose primary thrombectomy after informed consent. Thrombectomy was performed using stent-retriever device in addition to intra-arterial rtPA (2–10 mg). Mean number of passes was 1.6 ±. 0.9. Near complete (TICI2b) recanalization was observed in 5.56%% and complete (TICI3) in 94.44% of patients. Mean time to recanalization from symptoms onset was 188.5 ± 82.7 min. Immediate post-thrombectomy, 24 h and 30 day NIHSS score was 4.44 ± 3.75, 1.9 ± 3.2 and 0.28 ± 96 respectively. There was no procedure related complication. Asymptomatic perfusion related hemorrhage developed in 6 patients. 30 days mRS distributions was as followings: mRS0 38.89%, mRS1 44.44 % and mRS2 16.67%. 90 days outcomes were observed in followings: mRS0 50%, mRS1 44.44%, mRS2 5.56%). Conclusion: Our pilot study demonstrates that primary thrombectomy using SRT in AIS due to a LAO is not only safe and feasible, but associated with acceptable recanalization resulting in exceptional good functional outcome. Larger randomized controlled studies are needed. Disclosures Y. Lodi: None. Y. Lodi: None. V. Reddy: None. A. Devasenapathy: None. G. Petro: None. A. Hourani: None. C. Chou: None.