Abstract 183: Examining the Effect of Intra-Arterial Therapy on Outcomes in IV tPA Ineligible Ischemic Stroke Patients
Background: Recent randomized trials (RCTs) have failed to show benefit of intra-arterial therapy (IAT) compared with patients given IV tPA alone. Many patients, however, are ineligible for IV tPA, who were not included in IMS-3, MR-RESCUE or SYNTHESIS. We investigated potential treatment effects of IAT in patients with acute ischemic stroke ineligible for tPA.
Methods: In a US multicenter retrospective cohort study, we identified 476 AIS IV tPA ineligible patients with large artery occlusions (LAO) from 01/08 to 06/13. Inclusion criteria was <6hrs from symptom onset for anterior circulation and <12hrs for posterior circulation. Patients were divided into two arms (IAT vs No IAT). Logistic regression with good and bad (discharge mRS 0-2 and 4-6 respectively) outcome was performed to compare the two arms. Univariate and multivariate analyses evaluated independent predictors of good outcome after IAT.
Results: Table 1 shows baseline characteristics. Presentation >4.5 hrs (52%), high INR (11%) and recent procedure (10%) were the main reasons for IV tPA ineligibility. IAT patients had 4 times greater odds of good (OR 3.9, 95%CI 1.5-10, p=0.004) and significantly less odds of poor outcome (OR 0.3, 95%CI 0.17-0.55, p<0.0001) compared to those without IAT. Significance was maintained under nearly all conditions after adjustment was made for covariates (Table 2). The distribution of mRS scores demonstrated a shift towards better outcomes in IAT treated patients (Fig 1) in spite of higher death rates in this group. In univariate analysis, good ASPECTS (8-10), good reperfusion (TICI ≥2b) and time were independent predictors of good outcome after IAT. Start of IAT in the first 3hrs from onset was associated with 5 times the odds of a good outcome than later IAT initiation (5.3, 95%CI 1.99-14.6, p=0.001).
Conclusion: IAT may improve clinical outcomes in patients with LAO who are IV tPA ineligible. Testing for IAT efficacy in this patient population will require RCTs to validate our findings.
Author Disclosures: A. Sarraj: None. A.K. Boehme: None. C.J. Sun: None. W. Bibars: None. A. Olowu: None. C.W. Sitton: None. E.P. Supsupin: None. S. Martin-Schild: None. R. Gupta: None. J.C. Grotta: None. S.I. Savitz: None.
- © 2014 by American Heart Association, Inc.