Lack of Pre-treatment Thrombolysis and Low ASPECTS are Associated with Poor Rates of Recanalization After Mechanical Thrombectomy
Krithika Umesh Peshwe1, Muhammad Alvi2
1West Virginia University School of Medicine, 2West Virginia University
Objective:
To identify factors associated with poor rates of recanalization in patients with large vessel occlusion ischemic stroke undergoing mechanical thrombectomy.
Background:
Mechanical thrombectomy (MT) has been effective in treating ischemic strokes due to large vessel occlusion (LVO). However, all patients with LVO who are deemed candidates for MT do not have successful rates of recanalization and a favorable outcome. Hence, we studied factors associated with an unfavorable outcome in patients undergoing MT.
Design/Methods:
We retrospectively analyzed forty patients with LVO ischemic stroke undergoing MT. We included patients with anterior circulation LVO strokes who were deemed candidates for MT. Patient underwent CTA imaging upon arrival in the emergency room. We collected important variables including initial NIHSS, pre-morbid modified Rankin Scale (mRS), administration of thrombolysis, location of LVO, ASPECTS, TICI (thrombolysis in cerebral infarction) score. Functional outcome was measured with NIHSS and mRS at discharge.
Results:
40 patients with LVO who underwent MT (age 68 ±15); 62.4 % female; NIHSS 16). Patients were divided into four groups based on TICI scores into those with 0/1, 2b, 2c and 3. Variables including initial NIHSS, pre-morbid mRS, administration of thrombolysis, location of LVO, ASPECTS and TICI score were compared between these groups. In the TICI 0/1 group, patients had low ASPECTS on arrival and were not treated with thrombolysis prior to thrombectomy. They also had a higher NIHSS and mRS at discharge.
Conclusions:
Lack of pre-treatment thrombolysis and low ASPECTS on presentation were associated with poor rates of recanalization after mechanical thrombectomy.