Abstract W P7: Difficulty of Catheter Access to Occluded Target Vessel Predicts Worse Recanalization and Poor Outcomes
During endovascular procedures for acute ischemic stroke, catheter access to occlusion site may be technically difficult or impossible. We aim to study the impact of difficult catheter access to target occluded artery on clinical outcome in patients who received endovascular treatment in the IMS III trial.
Methods: From 434 patients randomized to receive endovascular therapy in the IMS III trial, we excluded patients with no groin puncture (11) or no treatable occlusion on initial angiogram (89). Patients were divided in four groups according to time from groin puncture to initiation of intra-arterial therapy (TGT) quartiles. Recanalization (TICI 2b-3) and favorable outcome (mRS 0-2 at 3 months) were defined.
Results: We included 334 patients that finally received transfemoral endovascular treatment: mean age 65.9±12.7 years, median NIHSS 17(IQR:14-21) and median time from stroke onset to groin puncture 204 minutes (IQR:170-236). In 23 patients (6.9%) occlusion was not accessible with microcatheter. In all patients distribution of TGT by quartiles was: Q1: 2-28 minutes, Q2: 29-40minutes, Q3: 41-57 minutes and Q4: 58-143 minutes. Rate of favorable outcome decreased as TGT increased: Q1:46.9%, Q2:39.5%, Q3:29.4%, Q4:29.9%. A longer TGT was associated with less favorable outcome (Q1-2: 43.2% Vs Q3-4: 29.5%; p=0.01). Patients in Q4 had a lower rate of recanalization (Q1-3: 42.75% Vs Q4: 29.2%; p=0.04)
Conclusion: In acute stroke patients receiving transfemoral endovascular therapies the time spent in accessing occlusion site is frequently longer than 30 minutes. Since longer access times are associated with worse outcome, strategies to reduce this time or alternative access should be studied to shorten procedural times and improve outcomes.
Author Disclosures: M. Ribo: Consultant/Advisory Board; Modest; Silk Road Medical. R. Sugg: Speakers' Bureau; Modest; Genentech. L.D. Foster: None. C.A. Molina: None. T.G. Jovin: Ownership Interest; Modest; Silk Road. T. Tomsick: Research Grant; Modest; Covidien. J.P. Broderick: Research Grant; Significant; NIH-NINDS. Other Research Support; Significant; Genentech. Speakers' Bureau; Modest; Oakstone Publishing. Consultant/Advisory Board; Modest; PhotoThera.
- © 2014 by American Heart Association, Inc.