Abstract T MP6: Angiographic Arteriovenous Shunting in Large Vessel Occlusion Strokes: Not an Ominous Sign
Background: The angiographic visualization of arteriovenous shunting (AVS) in large vessel occlusion strokes (LVOS) is thought to be a consequence of microcirculatory collapse in the setting of irreversible tissue injury and therefore may represent an ominous prognostic sign. We sought to establish the relationship between the presence of AVS on CT imaging characteristics and clinical outcomes in the Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR) trial.
Methods: STAR Trial patients with complete angiographic images were categorized according to the presence (AVS+) or absence (AVS-) of AVS at the end of the thrombectomy procedure. Baseline variables were compared to assess for any significant differences amongst the two groups. The impact of AVS on pre- and post-treatment CT imaging and in the rates of revascularization (TICI 2b-3), symptomatic intracranial hemorrhage (sICH), good functional outcomes (90-day mRS≤2), and 90-day mortality was subsequently analyzed.
Results: There was no significant differences in terms of age, baseline NIHSS, gender, time to treatment, or glucose levels between the AVS+ (n=52) and the AVS- (n=116) patients (Table 1). AVS+ patients had a non-significant trend towards more proximal occlusions. The presence of AVS did not have any significant impact on the rates of favorable CT imaging on either pre-treatment (AVS- vs. AVS+ ASPECTS>7: 65.5 vs. 72%;p=0.47) or post-treatment (ASPECTS>7:45.6 vs. 51%;p=0.61) scans. Similarly, AVS was not associated with any significant differences in the rates of good outcome (58.6 vs. 65.4%;p=0.49), mortality (8.6 vs. 3.8%;p=0.35), sICH (1.7 vs. 1.9%;p=0.92), or recanalization (89.7 vs. 92.3%;p=0.78).
Conclusions: In contrast to the current belief, the angiographic visualization of AVS in LVOS patients does not appear to have any meaningful consequences in terms of infarct size or clinical outcomes and therefore should not influence treatment decisions.
Author Disclosures: R.G. Nogueira: Consultant/Advisory Board; Modest; Stryker Neurovascular (PI Trevo-2 Trial; PI DAWN Trial), Covidien (Steering Committee SWIFT Trial and SWIFT-Prime Trial; Angiography Core Lab STAR Trial), Penumbra (Executive Committee 3D Separator Trial), Rapid Medical (Stroke Device Trial DSMB member). V. Mendes Pereira: Consultant/Advisory Board; Modest; global PI STAR, consultant for Covidien. A. Davalos: None. A. Bonafé: None. C. Castaño: None. A. Marcel: None. T. Liebig: Consultant/Advisory Board; Modest; Covidien and Stryker. R. Chapot: Consultant/Advisory Board; Modest; Covidien, Microvention and Balt. M. Goyal: Consultant/Advisory Board; Modest; Covidien. R. Sztajzel: None. F. Scalzo: None. M. Johnson: None. M. Besselmann: None. A. Moreno: None. G. Schroth: None. J. Gralla: Consultant/Advisory Board; Modest; global PI STAR, Covidien. D.S. Liebeskind: Research Grant; Modest; National Institutes of Health. Consultant/Advisory Board; Modest; Stryker and Covidien.
- © 2014 by American Heart Association, Inc.