Abstract T MP6: The Effect of Proximal Arterial Stenosis on Outcomes Following Interventional Therapy for Acute Ischemic Stroke in the IMS-III Trial
Introduction: In patients undergoing interventional treatment for acute ischemic stroke (AIS), arterial stenosis proximal to the intracranial arterial occlusive lesion (AOL) may decrease the probability of technical success and result in worse outcomes. We examined the impact of proximal arterial stenosis in the Interventional Management of Stroke (IMS)-III trial.
Hypothesis: Arterial stenosis proximal to the intracranial AOL impedes successful interventional therapy for AIS resulting in worse outcomes.
Methods: A total of 369 patients receiving combination intra-arterial (IA) and intravenous (IV) therapy for anterior circulation AIS in the IMS-III trial were categorized according to the degree of Internal Carotid Artery (ICA) stenosis proximal to the index AOL, as determined by immediate pretreatment digital subtraction angiography. Patients with severe stenosis or occlusion (≥70%, n=37) were compared to patients without severe stenosis (<70%, n=332). Modified Rankin scores (mRS) at 90 days, 24-hour mean infarct volumes, time to reperfusion, and symptomatic intracerebral hemorrhage (sICH) rates were evaluated.
Results: When compared to those with ≥70% stenosis, patients with <70% stenosis had a lower mean mRS at 90 days (2.9 vs 3.3, p=0.10), greater percentage of mRS 0-2 (43.5 vs 34.3%, p=0.15), smaller mean infarction volume (70.1 vs 87.6mL, p=0.18), shorter mean time to reperfusion (78.7 vs 105.7 minutes, p=0.002), and a higher rate of sICH (7.3 vs 2.7%, p=0.15).
Conclusion: In patients receiving combined IV/IA treatment for AIS, ipsilateral ICA stenosis of ≥70% is associated with a statistically significant longer time to reperfusion, and trends favoring larger infarct volumes and worse clinical outcomes despite a lower rate of sICH.
Author Disclosures: S.L. Gogela: None. T. Abruzzo: None. Y. Gozal: None. A. Ringer: Expert Witness; Significant; $10,000. P. Khatri: Research Grant; Modest; Dr. Khatri’s Dept of Neurology receives support for her role DSMB member from Biogen, Inc.. Research Grant; Significant; Dr. Khatri’s Dept of Neurology receives support for her roles as: (1) Lead PI of the PRISMS trial from Genentech, Inc and (2) Neurology PI of the THERAPY trial from Penumbra, Inc.. J. Broderick: None. T. Jovin: None. T. Tomsick: None.
- © 2015 by American Heart Association, Inc.