Abstract WP27: Time to Recanalize an Acute Vessel Occlusion from Groin Puncture Matters Among Patients Selected for Intra-Arterial Therapy based on CT Perfusion Imaging
INTRODUCTION: Mechanical thrombectomy has an established role in the management of acute ischemic stroke (AIS). We investigate whether procedure time is related to recanalization, intraprocedural complications and functional outcome.
Methods: A retrospective review was performed of all AIS cases that underwent intra-arterial (IA) intervention between May 25, 2008 and August 7, 2012. Candidacy for IA therapy was determined by CT perfusion imaging irrespective of onset time. Demographics, procedural times, time to recanalization, recanalization status, procedural complications and ninety day outcome defined by modified ranking scale (mRS) were extracted.
Results: One-hundred and fifteen patients were identified (53% female; mean age 66.5 ± 15 years) with a mean time to treatment 11 hr 16 min and an NIHSS of 15.6 ± 7. Forty-nine patients (42.6%) received intravenous tPA prior to IA therapy. Occlusions involved the anterior circulation in 88% of patients. Mean procedure time for mechanical thrombectomy was 1hr 39 min ± 44 min and ninety-six (83%) received adjunctive IA thrombolysis with tPA. TICI IIB or III was achieved in ninety-four (81.7%) patients with an overall complication rate of 7.8% (9/115). In forty-one patients (35.6%), recanalizations were achieved in less than one hour (‘Immediate Recan’) compared to 64% in which procedures lasted greater than one hour (‘Delayed Recan’). Among those in the ‘Immediate Recan’ group, TICI IIB or greater was achieved in 90% (37/41) as compared to 77% (57/74) in the ‘Delayed Recan’ group. The intra-procedural complication rate was similar between the two groups (7.3% vs. 8.2%). Ninety-day mRS was more favorable among the ‘Immediate Recan’ group, in particular among those achieving a mRS 0-2 (mRS 0=20%, 1-2 = 36.7%, 3-5 = 23.3%, 6=20%) compared to the ‘Delayed Recan’ group (mRS 0=11%, 1-2 = 25%, 3-5 = 38%, 6=25.4%).
Conclusions: For patients undergoing IA therapy for AIS based on CT perfusion imaging, interventions lasting greater than one hour are not associated with a higher intra-procedural complication rate, but are associated with a lower likelihood of achieving a TICI IIB or greater and an mRS </= 2 at ninety days compared to recanalizations occurring in less than one hour.
- © 2012 by American Heart Association, Inc.