Abstract 192: Throwing The Kitchen Sink At Tandem Occlusions: A Safety Analysis

Abstract

Introduction The risk of tandem occlusion treatment in the setting of intravenous thrombolysis is unclear. Angioplasty and stenting typically require the administration of glycoprotein IIb/IIIa inhibitors and/or dual‐antiplatelets which may increase the risk of hemorrhage in the setting of recent thrombolysis administration. Methods We conducted a retrospective analysis of a prospectively maintained patient registry at a comprehensive stroke center. Patients who received thrombolysis and subsequently underwent endovascular therapy for acute ischemic stroke between 2012 and 2022 were included. Patients were separated into two groups depending on whether or not rescue angioplasty or stenting was performed. Per local practice patterns, patients who underwent angioplasty or stenting were immediately started on dual antiplatelets with or without a glycoprotein IIb/IIIa inhibitor bridge. Baseline demographics and clinical characteristics were compared. Outcomes of interest included symptomatic intracerebral hemorrhage (ICH), asymptomatic ICH, hemorrhagic transformation, mass effect and death. Analysis was completed using Chi Square and Fisher’s exact test for categorical variables and Mann‐Whitney U for continuous variables. Results Baseline demographics and clinical characteristics were compared between groups. Patients who underwent treatment of a tandem occlusion were on average younger (67 vs 73, p=0.08) and male (70.1% vs 55%, p=0.03). Median LDL was higher (94 vs 67, p=0.01) and there was a higher rate of diabetes (55.2% vs 40%, p=0.03) and lower rate of atrial fibrillation (12.1% vs 26.6%, p=0.01). Median NIHSS on admission was lower in the tandem occlusion group (15 vs 18, 0.02). Otherwise groups did not significantly differ in level of hemoglobin a1c or rates of hypertension, coronary artery disease, congestive heart failure, smoking status or prior stroke or transient ischemic attack. There was no significant different in hemorrhagic transformation (OR 1.02, 95% CI 0.49, 2.13), mass effect (OR 1.73, 95% CI 0.79, 3.79), symptomatic intracranial hemorrhage (OR 1.27, 95% CI (0.54, 2.99), asymptomatic intracerebral hemorrhage (OR 0.53, 95% CI 0.12, 2.43) or death (OR 0.55, 95% CI 0.24, 1.22) between groups. Limitations include a single center study and the retrospective nature of this analysis. Conclusion We did not find significant risk associated with the treatment of tandem occlusions in the setting of intravenous thrombolysis. Future prospective, multi‐center studies would be beneficial.