Interventional Therapy for Acute Ischemic Stroke Is Associated with Poor Outcomes (P05.214)

Abstract

Objective: To determine patient populations that benefit from intra-arterial (IA) interventional therapy for acute ischemic stroke. Background IA therapy is becoming more frequently used, but outcome data and predictors of good outcome are limited. Design/Methods: Retrospective analysis of patients treated at a single stroke center between 2006-2010. Demographic, laboratory, and clinical data were retrospectively collected. Admission and discharge NIH stroke scale (NIHSS) and modified Rankin Scale (mRS) were recorded. When missing, scores were retrospectively calculated. Imaging characteristics, such as ASPECT score, vessel occlusion, post-treatment hemorrhage, and time to treatment were identified. A poor outcome was defined as mRS ≥3. Results: We identified 66 patients; 42% were women, 47% African-American. Mean age was 63(±16) (range: 27-87) years. All patients had pre-stroke mRS of ≤2. Median pre-treatment NIHSS was 21.5 (range:10-38). On baseline CT scan, mean ASPECTS score was 9(±1.1). ASPECTS score on CTA source images and the non-contrast scan did not correlate (r 2 =0.21). Before IA therapy, IV tPA was administered in 29/66 (44%) patients; treatment with IV tPA did not correspond with discharge mRS ≤3 (p=0.54). Stroke onset-IA treatment interval was 355 (±194) minutes; time to treatment and discharge mRS did not correlate (r 2 =0.02). Median discharge NIHSS of surviving patients was 11 (range: 0-26). Discharge mRS was ≥3 in 89% of patients, including 21 (32%) of 66 patients who died. Hypotension (SBP Conclusions: Interventional therapy for acute ischemic stroke is likely to produce poor outcomes (mRS ≥3) at discharge. Recanalization of basilar artery occlusion usually results in improved outcomes. Pre-treatment with IV tPA may make no significant difference in early neurological recovery. Further study of this topic is needed. Disclosure: Dr. Simpson has nothing to disclose. Dr. Marin has nothing to disclose. Dr. Penstone has nothing to disclose. Dr. Mitsias has nothing to disclose.