Abstract 201: Effect of Endovascular Reperfusion in Relation to Site of Arterial Occlusion: A Pooled Analysis of Individual Patient Data
Background: Previous studies have shown an association between reperfusion and good clinical outcome, but it is unknown if this association differs depending on the site of the arterial occlusive lesion (AOL). We pooled individual patient data from prospective endovascular stroke studies to assess this.
Methods: We included data from the endovascular arm of IMS III, a trial of intravenous (IV) thrombolysis alone versus IV thrombolysis and endovascular treatment; SWIFT, a trial comparing the Solitaire with the Merci device; STAR, a cohort study of patients treated with the Solitaire device; and DEFUSE 2, a cohort study of patients who received endovascular therapy. We compared the strength of the associations between reperfusion and clinical outcomes in patients with ICA, M1 and M2/3/4 (M2+) occlusions. The primary outcome was good functional outcome at day 90 defined as a modified Rankin Scale 0-2. Secondary outcomes included 90-day mortality and symptomatic intracranial hemorrhage (sICH).
Results: 710 Patients were included in the analysis. The site of the AOL was ICA in 161, M1 in 389, and M2+ in 160 patients (M2=131, M3=23 and M4=6). The association between reperfusion and good functional outcome was stronger for patients with ICA occlusions (45% vs 19%; OR 3.5, 95%CI 1.7-7.2) and M1 occlusions (58% vs 18%; OR 6.2, 95%CI 3.8-10.2) than for patients with M2+ occlusions (53% vs 45%; OR 1.4, 95%CI 0.8-2.6) (p for difference in ORs=0.003). Mortality was reduced with reperfusion in patients with ICA (39% vs 18%; OR 0.4, 95%CI 0.2-0.7) and M1 occlusions (30% vs 10%; OR 0.3, 95%CI 0.2-0.5), but not in patients with M2+ occlusions (15% vs 15%; OR 1.0, 95%CI 0.4-2.3). Reperfusion was associated with fewer incidences of sICH without evidence of an interaction with AOL (OR 0.3, 95%CI 0.2-0.6).
Conclusion: The association between endovascular reperfusion and improved clinical outcomes is more profound in patients with ICA and M1 occlusions than in patients with M2+ occlusions. This differential response to reperfusion has important implications for the design and power calculations of endovascular stroke trials.
Author Disclosures: R. Lemmens: None. S. Hamilton: None. D. Liebeskind: Consultant/Advisory Board; Modest; Stryker, Covidien. Research Grant; Significant; NIH-NINDS. T. Tomsick: None. A. Demchuk: Honoraria; Modest; Covidien honoraria for CME. Research Grant; Significant; Unrestricted grant for ESCAPE trial: Covidien. R. Nogueira: Other Research Support; Modest; Stryker; PI for the TREVO-2 and DAWN Trials, Penumbra; Executive Committee for the 3D Separator Trial. Other Research Support; Significant; Covidien; Steering Committee for the SWIFT and SWIFT Prime Trials and Core Lab for the STAR Trial. M. Marks: None. R. Jahan: Speakers' Bureau; Modest; Stryker. Consultant/Advisory Board; Modest; Covidien, Medina Medical. J. Tran: Employment; Significant; Covidien. J. Gralla: None. J. Nonato: Employment; Significant; Covidien. N. Uppuluri: Employment; Significant; Covidien. A. Yoo: Other Research Support; Modest; Dutch Heart Foundation. Research Grant; Significant; Penumbra Inc.. Y. Palesch: None. V. Mendes Pereira: None. J. Broderick: Other Research Support; Modest; Research support for prisms trial Genentech, Study drug ims III trial - genentech. J.L. Saver: Other; Modest; The University of California. G.W. Albers: Consultant/Advisory Board; Modest; Covidien, iSchemaView, Lundbeck. Other; Modest; Equity interest: iSchemaView. M.G. Lansberg: None.
- © 2015 by American Heart Association, Inc.