Abstract Details

Title SOLID-SMART (SOLItaire Device Using SMART Criteria): Selecting Patients for Solitaire Device Use Following IV Thrombolysis Using CT Perfusion

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P06 - (-)

Poster/Presentation
Number 269

Objective

Background BACKGROUND: Recently the Solitaire device received FDA-approval in acute ischemic stroke (AIS). However, little if any data exist on feasibility, safety or utility of CTP in these patients.

Design/Methods DESIGN/METHODS: Open label retrospective review of consecutive AIS patients treated with Solitaire who received CTP prior to IA treatment. Use of additional therapy (IV rt-PA or other endovascular procedures) was assessed. Outcome was determined by radiologic and clinical measures (NIHSS), and safety by sICH.

Results RESULTS: There were 18 patients (39% male); mean age was 61 (range 42-97). 16 (89%) received full-dose IV rt-PA. 2 also received IA rt-PA and 3 had >1 vessel treated. 14/18 (77%) experienced successful recanalization (TICI2b or 3). The mean time to revascularization was 503 min (range 240-1003); 4 had time to groin puncture >8hrs. 17/18 received CTP after IV rt-PA, and prior to Solitaire. 15 had a perfusion mismatch, 2 a matched perfusion defect. Of patients with mismatch who recanalized after Solitaire, 10/12 (83%) showed less infarct growth (smaller DWI volume as compared to area at risk on CTP), and better clinical outcome (mean pre and post-NIHSS 13.3 and 9.1, p=0.05). Of those with perfusion mismatch without recanalization or matched perfusion defect regardless of recanalization, 4/5 had equal or larger infarct size on follow-up imaging and worse clinical outcome (mean pre and post-NIHSS 19.4 and 34.6, p=0.15). This difference was significant (p=0.028). There were no sICHs. Mortality was 33% (6/18).

Conclusions CONCLUSIONS: Selection of patients for Solitaire following IV rt-PA based on CTP is safe and effective. Successful recanalization in patients with perfusion mismatch predicts reduced infarct growth and improved clinical outcomes, despite long time to IA treatment. Moreover this approach substantially reduces sICH rate (0%) despite frequent use of IV/IA thrombolysis.

Authors/Disclosures
nobl barazangi, MD, PhD PRESENTER	Dr. Barazangi has nothing to disclose.
Fulton Velez	No disclosure on file
Christine S. Wong, MD	No disclosure on file
Joey English, MD, PhD	No disclosure on file
Charlene Chen, MD (Denali Therapeutics)	No disclosure on file
Jack C. Rose, MD (Washington Township Medical Group)	No disclosure on file
Oana Spataru, MD	No disclosure on file
	No disclosure on file
	No disclosure on file
David C. Tong, MD, FAHA	No disclosure on file

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