Abstract T P24: Endovascular Thrombectomy in Non-Intubated Patients for Basilar Artery Occlusive Disease is Associated With Improved Outcomes
Background and Purpose: Basilar artery occlusive disease is associated with poor outcomes and high rates of mortality in the absence of recanalization. Intra-arterial thrombectomy can lead to improved outcomes in a subset of patients, but the determinants of these outcomes are poorly understood. Patients are often routinely intubated prior to thrombectomy for concern of poor mental status and potential procedural complication risk in an uncooperative patient, however intubation itself carries an associated complication profile. We sought to understand the outcomes in patients undergoing thrombectomy with intravenous conscious sedation (IVCS) versus general anesthesia (GA).
Methods: A review of our prospectively maintained endovascular stroke database identified 103 patients presenting with basilar occlusion.
Results: 79 patients underwent GA and 24 patients underwent IVCS. There were no significant differences in age, gender or stroke risk factors between the two groups. The average NIHSS was higher in the GA group versus the IVCS group (21 vs. 14, p=0.006)- this variable was also controlled for as a potential confounder in the multivariate analysis. Rates of TICI 2b/3 recanalization had a trend towards being slightly higher in the IVCS group (92% vs 84%, p=0.26). In the GA group, there was a trend towards higher rates of wire perforation (9% vs 0%, p=0.14) and hemorrhage (11% vs 0%, p=0.08), and there was a significantly higher incidence of in-hospital death (47% vs 17%, p=0.008). In the IVCS group, there was a higher rate of good outcomes (mRS 0-2 at 3 months, 63% vs 23%, p=0.00045). In multivariate analysis, the following variables were significantly associated with good outcomes: lower age (p 0.010), TICI 2b/3 recanalization (p=0.040) and IVCS (p=0.0035).
Conclusions: In addition to age and TICI 2b/3 quality recanalization, the use of IVCS is associated with improved outcomes in patients with basilar artery occlusive disease undergoing thrombectomy. These data also suggest the safety and efficacy of endovascular thrombectomy in non-intubated patients. Routine and elective intubation of patients undergoing IA therapy should be avoided if possible as it may be associated with higher complication rates and poor outcomes.
Author Disclosures: A.P. Jadhav: None. M. Starr: None. M. Juuma: None. Z. Syed: None. M. Hammer: None. V. Reddy: None. B. Jankowitz: None. L. Wechsler: None. T. Jovin: None.
- © 2014 by American Heart Association, Inc.