Abstract W P11: Factors Affecting Vascular Neurologists' Decisions to Pursue Endovascular Intervention of Acute Ischemic Stroke Patients
Background: Intra-arterial therapy (IAT) is an approach to promote recanalization in acute ischemic stroke (AIS) patients. While IAT continues to go through further evaluation in multiple phase III trials using new devices and focusing on time improvement, patients with LAO continue to be treated with IAT. Multiple clinical, radiographic and time factors go into vascular neurologists’ decisions whether to pursue IAT or not. We aimed to evaluate factors affecting determination of IAT for stroke amongst patients transferred to tertiary centers.
Methods: A US multicenter retrospective cohort analysis was conducted on 313 consecutive transferred patients who met vessel criteria from 01/08-4/14. Collateral were measured by the collateral score (CS). ASPECTS decay was defined as a change from good (8-10) to poor (0-7) scores between center CT scans. IAT patients were compared with no IAT patients with regard to factors predictive of IAT.
Results: Table 1 shows baseline characteristics of the two groups. Age was not a predictor of IAT. NIHSS was associated with IAT, but was not a predictor of IAT. For each escalating point on CS, the odds of IAT increased more than 4 times (OR 4.27, 95% CI 2.86-7.87, p<0.0001). For each declining point on ASPECTS, the odds of IAT decreased by 22% (OR 0.78, 95% CI 0.72-0.85, p<0.0001). ASPECTS decay was associated with an 83% reduction in the odds of IAT (OR 0.17, 95% CI 0.05-0.52, p<0.0001). For every 30 minutes of time between centers, the odds of ASPECTS decay increased by 13% (OR 1.13, 95% CI 1.11-1.17 p=0.0004) and IAT chances reduced by 9% (OR 0.91, 95% CI 0.84-1.00, p=0.05).
Conclusions: Infarction evolution measured by ASPECTS decay, collaterals status and time from stroke ictus are all major determinants of the vascular neurologist decision whether to proceed with IAT. Our findings further support the time-sensitivity of the process for transferring candidates for IAT.
Author Disclosures: A. Sarraj: None. S. Martin-Schild: None. A.K. Boehme: None. E.P. Supsupin: None. C.W. Sitton: None. S.S. Bajgur: None. J.M. Choi: None. P. Datta: None. T. Wu: None. E.E. Bonafante-Mejia: None. E. Friedman: None. M.J. Dannenbaum: None. P.R. Chen: None. C.J. Sun: None. A.D. Barreto: None. R. Gupta: Consultant/Advisory Board; Modest; Stryker Neurovascular, Covidien. J.C. Grotta: None. S.I. Savitz: None.
- © 2015 by American Heart Association, Inc.