Abstract 3946: Determinants and Outcomes Associated with Withdrawal of Care following Endovascular Treatment in Acute Ischemic Stroke Patients.
Background: Withdrawal of care although frequently used may prematurely reduce the odds of recovery in patients with acute ischemic stroke. We performed this study to provide a better understanding of physician practices in withdrawal of care following endovascular treatment in acute ischemic stroke patients.
Objective: Our goal was to identify frequency and factors associated with endovascular treatment that increase the odds of withdrawal of care in consecutive series of acute ischemic stroke patients.
Methods: We reviewed consecutive acute ischemic stroke patients treated with endovascular treatment over a 5-year period. Demographics characteristics, National Institute of Health Stroke Scale (NIHSS) score before and after the procedure, and modified Rankin scale (mRS) at discharge were collected. The Qureshi grading scale was used to evaluate angiographic recanalization. We analyzed whether the presence of successful recanalization, or post-procedure intracerebral hemorrhage (ICH), was associated with withdrawal of care after age and 24 hr NIHSS score adjustment. The effect of withdrawal of care on poor outcome (mRS 3-6) at discharge was determined after adjusting for age and admission NIHSS score.
Results: A total of 186 patients underwent endovascular treatment, mean age + SD: 65 (±17) years, 100 (54%) men, and mean NIHSS score ± SD: 15.5+ 7. Sixty four patients received intra-arterial thrombolytic only, 28 mechanical thrombectomy only, and 75 combined lytic/mechanical thrombectomy. Among all, 142 patients (77%) had vessel recanalization. Of these, 17 (9%) underwent withdrawal of care. 14% of the patients with recanalization versus 8% without recanalization underwent withdrawal of care (p=NS). Overall there were 37 patients who developed post-procedure ICH, but this occurrence was not associated with withdrawal of care status (p=NS). After adjusting for age and admission NIHSSS, there was no relationship between angiographic recanalization with withdrawal of care (OR=0.5, p=0.3). Patients who underwent mechanical thrombectomy during endovascular treatment had significant correlation with withdrawal of care compared to intra-arterial thrombolytic therapy alone (OR=10, p=0.02).
Conclusion: Withdrawal of care, although infrequent, contributes to poor outcome at discharge in patients undergoing endovascular procedure for acute ischemic stroke. However, the choice of withdrawal of care is not related to angiographic recanalization or post-procedural ICH.
- © 2012 by American Heart Association, Inc.