Abstract WP18: Futility and Predicted Therapeutic Gain of Endovascular Treatment According to the Baseline Stroke Severity in Acute Ischemic Stroke
Introduction: To describe the distribution of futile recanalization, defined by 3-month modified Rankin scale (mRS) 3 to 6 despite of successful recanalization (Thrombolysis in Cerebral Infarction grade 2b-3), and therapeutic gain of endovascular treatment (EVT) across the whole range of initial National Institutes of Health Stroke Scale (NIHSS) in patients with acute ischemic stroke attributable to major cerebral artery occlusion.
Methods: Using a prospective multicenter stroke registry database, acute ischemic stroke patients, who were confirmed anterior circulation large artery occlusion and were treated with EVT within 12h of onset between November 2009 and July 2014, were identified. Futile recanalization rates were described across the whole range of NIHSS score, categorized as ≤ 5, 6∼10, 11∼20 and >20. To estimate therapeutic gain, defined as a difference in the proportions of mRS 3-6 between those recanalized completely with EVT and those not treated, a proportion of mRS 3-6 in those not treated was obtained through age-specific direct standardization using a population who were hospitalized within 12 h due to acute ischemic stroke, had major anterior circulation large artery occlusion and were not treated with recanalization therapy.
Results: Among 21,591 patients with acute ischemic stroke, 4.5% (n=972) received EVT within 12 h of onset. Of those 972 patients, 54.8% (n=533) were successfully recanalized. Of those 533, 440 with anterior circulation larger artery occlusion were enrolled for study (male 58%, age 67.3±12.3 years, onset to EVT starting time 4.19±1.96 hours). Seventy percent of patients were treated with intravenous alteplase prior to EVT. Futile recanalization was observed in 51.4% (n=226). Futile recanalization increased with the increase of stroke severity; 20.9% in NIHSS≤ 5; 34.6% in 6∼10; 58.9% in 11∼20; 63.8% in >20 (p for trends <0.001). Therapeutic gain of EVT significantly differed by initial stroke severity (p for interaction<0.001); -1.9% in NIHSS≤ 5; 14.3% in 6∼10; 27.7% in 11∼20; 34.3% in >20.
Conclusions: This study emphasized the impact of initial stroke severity on futile recanalization and therapeutic gain in patients receiving EVT for acute ischemic stroke caused by anterior circulation large artery occlusion.
Author Disclosures: S. Lee: None. B. Kim: None. M. Han: None. S. Park: None. T. Park: None. K. Lee: None. B. Lee: None. K. Yu: None. M. Oh: None. M. Jang: None. J. Cha: None. J. Cha: None. D. Kim: None. H. Nah: None. J. Lee: None. S. Lee: None. Y. Ko: None. J. Park: None. K. Kang: None. Y. Cho: None. K. Hong: None. J. Choi: None. J. Kim: None. K. Choi: None. D. Kim: None. W. Kim: None. J. Lee: None. J. Lee: None. H. Bae: None.
- © 2016 by American Heart Association, Inc.