학술논문
Abstract P473: Perfusion Imaging Identifies Patients With Mild Deficits Due to Large Vessel Occlusion Who May Benefit From Endovascular Thrombectomy: A Pooled International Cohort Study
Document Type
Article
Author
Sarraj, Amrou; Ribo, Marc; Blasco, Jordi; Perez de la Ossa, Natalia; Chen, Michael; Hassan, Ameer E; Wu, Teddy Y; Cordato, Dennis; Kleinig, Timothy J; Schaafsma, Joanna D; Blackburn, Spiros; Abraham, Michael G; Gibson, Daniel; Wallace, Adam; Pujara, Deep; Shaker, Faris; Moreno Negrete, Javier; Beharry, James; Cappelen-Smith, Cecilia; Rodríguez-Esparragoza, Luis; Olivé Gadea, Marta; Requena, Manuel; Pereira, Vitor; Day, Arthur L; Sitton, Clark; Martin-schild, Sheryl B; Song, Sarah; Mitchell, Peter J; Parsons, Mark; Grotta, James C; Albers, Greg
Source
Stroke (Ovid); March 2021, Vol. 52 Issue: Supplement 1 pAP473-AP473, 1p
Subject
Language
ISSN
00392499; 15244628
Abstract
Background:Efficacy and safety of endovascular thrombectomy (EVT) in large vessel occlusion (LVO) patients with mild deficits is unclear.Methods:Pooled cohort of pts with mild deficits (NIHSS<6) due to (ICA, M1, M2) LVO from EXTEND IA TNK I & II RCTs and prospective data from 12 centers (US, AUS, NZ, Canada, Spain) from 1/2013 to 2/2020 was divided into medical management (MM) vs EVT. All pts had baseline CT, CTA, CTPRAPID software estimated ischemic core and mismatch. Pts stratified into with or without target profile (≥1cc core / mismatch ratio ≥ 1.8 / mismatch volume ≥ 15cc). Primary outcome- excellent (90 day mRS 0-1); Secondary- mRS shift, safety (sICH, neuro-worsening, mortality).Results:Of 371 pts, 189 (51%) had EVT. Time LKW to EVT center: EVT 165 (70- 416) vs MM 200 (72-564) min, p=0.35 were similar. EVT pts had larger perfusion lesions (51 cc (23-86) vs 30.1 (5, 65), p<0.001), higher NIHSS 4 (2-5) vs 3 (2-4), p=0.009), less IV tPA (30% vs 41%, p=0.044), more M1s (44% vs 29%, p<0.001). 93 pts (25%) had target profile, of whom 60% had EVT. Of 278 without target profile, 48% had EVT. Among all pts, excellent outcomes and mRS distribution were similar (EVT 63.5% vs MM 59.1%, aOR 1.55, 95%, p=0.16) and (adj cOR 1.44, p=0.16) Fig 1A. EVT had worse safety; sICH (6% vs 0%, p=0.002); neuro-worsening (19% vs 3%, p<0.001) and mortality (5% vs 1%, p=0.06). With target profile, EVT associated with more excellent outcomes (66% vs 49%, aOR 4.44, 95% CI 1.04-18.95, p=0.04), shift to better outcomes (adj cOR 2.9, 95% CI 1.03-7.91, p=0.04) Fig 1B. Safety was similar; sICH 2% vs 0%, p>0.99, neuro-worsening 17% vs 6%, p=0.30) and mortality 5% vs 3%, p>0.99). Without target profile, excellent outcomes were similar without a shift, Fig 1C. Safety was worse with EVT: sICH 8% vs 0%, p=0.001; neuro-worsening 20% vs 3%, p<0.001).Conclusion:EVT was not associated with improved outcomes in patients with mild deficits; safety was worse. However, EVT was safe and associated with improved outcomes in target profile patients.