Abstract W P24: Choice of Thrombectomy Device and Degree of Collateral Flow Predict Reperfusion in DEFUSE 2
Background: Endovascular therapy for acute ischemic stroke is an effective tool for recanalizing occluded vessels. We sought to determine the factors associated with successful reperfusion and whether any differences in reperfusion rates existed between hospital sites.
Methods: Stroke patients underwent endovascular treatment as part of the DEFUSE 2 study at nine hospital sites between 2008 and 2011. Patients were included for analysis if they had a baseline TICI score of 0 or 1. Successful reperfusion was defined as a TICI reperfusion score of 2b or 3 at the completion of the procedure. Collaterals were assessed using the Collateral Flow Grading System and were dichotomized as poor (0-2) or good (3-4). The relationship between clinical, neuroimaging and treatment variables and TICI reperfusion was assessed using logistic regression.
Results: Eighty-nine patients had a baseline TICI score of 0 or 1; thirty-six patients achieved successful TICI reperfusion. Patients were treated with the Merci clot retriever (n=25), the Penumbra device (n=19), both Merci and Penumbra (n=17), or other endovascular therapies (n=28). Other interventions included manual aspiration (n=20), stent retrievers (n=7) and angioplasty (n=7). Variables associated with successful reperfusion in univariate analyses were: good collaterals (p<0.01), location of artery occlusion (p<0.05), use of the Merci retriever (p<0.01), and hospital site (p<0.01). In multivariate analysis, good collaterals (p<0.01) and use of the Merci retriever (p<0.05) remained as independent predictors of successful reperfusion.
Conclusion: In acute stroke patients who undergo endovascular therapy, good collateral flow to the ischemic brain region and use of the Merci retriever are associated with successful reperfusion. The rates of successful reperfusion differed between hospital sites. This may have been driven by variation in the rates of use of the Merci retriever.
Author Disclosures: J.T.P. Liggins: None. M. Mlynash: None. M. Straka: None. S. Kemp: None. R. Bammer: Ownership Interest; Significant; iSchemaView. M.P. Marks: None. G.W. Albers: Ownership Interest; Modest; iSchemaView. M.G. Lansberg: None.
- © 2014 by American Heart Association, Inc.