Abstract 1122‐000186: Predictors of Functional Outcome in Ischemic Stroke Patients with High Pass Number During Endovascular Therapy

Abstract

Introduction: The number of thrombectomy passes during endovascular therapy (EVT) for large vessel occlusion (LVO) in acute ischemic stroke (AIS) has been associated with probability of favorable functional outcome, with worse outcomes correlating with greater pass number. While first‐pass recanalization is a strong predictor of functional outcomes, the optimal or maximum recommended number of passes at which patients continue to benefit from EVT remains controversial. Moreover, among patients requiring more attempts, it is unclear if a certain subset of patients continue to benefit despite multiple passes. In this study, we determine predictors of functional outcome among patients requiring a high pass number to achieve successful vessel recanalization. Methods: From our prospectively maintained multi‐institutional registry across 4 comprehensive stroke centers, we identified patients with LVO AIS who underwent EVT requiring ≥ 3 passes to achieve successful reperfusion, defined as ≥ TICI 2b. Patient demographics, co‐morbidities, and severity of stroke based on NIHSS and ASPECTS were included within the analysis. Favorable outcome was defined as 90‐day post‐stroke modified Rankin Scale (mRS) 0–2. The primary outcomes were predictors of favorable outcome, which was assessed by multivariable logistic regression adjusted for age, baseline mRS, NIHSS, admission systolic and diastolic blood pressure, administration of tPA, number of passes during thrombectomy, history of hypertension, hyperlipidemia, atrial fibrillation, coronary artery disease, congestive heart failure, carotid stenosis, and diabetes. Results: Among 116 patients, median age was 70 (IQR 59–80), 48% were female, median NIHSS was 16.5 (IQR 13–22), and median number of passes was 3 (IQR 3–4, range 3–8). Patients with favorable outcome were younger (mean age 63±18.1 vs 70±14.5, favorable vs. non‐favorable, p = 0.041), and had lower NIHSS on presentation (mean 13.9±6.0 vs 18.3±7.4, favorable vs. non‐favorable p = 0.003). Patients with favorable outcome also had lower initial systolic blood pressure (149.6±32.8 vs 163.0±30.0 mmHg, favorable vs. non‐favorable, p = 0.047). In multivariable logistic regression adjusted for demographics and clinical characteristics, lower NIHSS was significantly associated with likelihood of good outcome (OR 0.88, 95% CI 0.81‐0.97, p = 0.009). Conclusions: Patients presenting with lower NIHSS are more likely to benefit from continued EVT attempts. These findings suggest that this population benefits from continued attempts at revascularization.

Keywords

• Ischemic Stroke
• Acute Stroke
• Endovascular Therapy
• Mechanical Thrombectomy