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Abstract Details

Determinants of Early Outcomes in Patients with Acute Ischemic Stroke and Proximal Artery Occlusion
Cerebrovascular Disease and Interventional Neurology
S02 - (-)
005
Proximal artery occlusions (PAO) are thought to recanalize in 10% of patients with AIS treated with intravenous tPA (IV tPA) alone, yet the benefits of intra-arterial therapy in this patient subgroup are not well-established.
Using a pre-specified protocol, 193 patients from our institutional GWTG-Stroke database admitted between 01/01/2007-12/31/11 were deemed LTB. These patients had evidence of PAO (ICA, MCA M1 or proximal M2 segments), brain imaging completed <6hours from last known well time, NIHSS score ?8, and early ischemic changes that were ?100cc. Logistic regression was used to determine independent predictors of favorable (discharge to home or acute rehab) versus unfavorable (discharge to skilled nursing facility, hospice, or in-hospital mortality) outcome.
Of the patients included, 29.5% received IV tPA only, 11.4% underwent IAT only, and 37.8% had both. Overall in-hospital mortality was 19.2%. Fourteen percent of LTB patients ambulated independently on discharge and went directly home. In a univariate analysis, age (OR 0.95, 95%CI 0.92-0.97), IV tPA (OR 2.3, 95%CI 1.2-4.3), and history of atrial fibrillation (OR 0.5, 95%CI 0.3-0.9) were associated with outcome. Effect of IAT was not statistically significant (OR 1.3, 95%CI 0.7-2.3; p=0.4). The odds of favorable post-stroke outcome were significantly lowered (OR 0.3, 95%CI 0.1-0.6; p=0.0006) in those receiving neither IV tPA nor IAT.
In acute ischemic stroke patients thought LTB from IAT, IV tPA independently predicted favorable early post-stroke outcomes. These data reinforce the recommendation to provide early, rapid IV tPA to all eligible patients. Further studies are warranted to explore the lack of IAT effect seen in this study, which may be due to small sample size, residual confounding, or interaction between the IV tPA and IAT.
Authors/Disclosures

PRESENTER 		No disclosure on file
No disclosure on file
Mark A. Ross, MD, FAAN (Specialty Care) No disclosure on file
Syed T. Ali, MBBS, BSc, MD (Syed T Ali MD PLLC) No disclosure on file
No disclosure on file
No disclosure on file
Lee H. Schwamm, MD, FAAN (Yale New Haven Health System) Dr. Schwamm has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Prime 好色先生. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for lifeimage. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for mediasphere. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving as a Consultant for medscape/WebMD. Dr. Schwamm has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Penumbra. Dr. Schwamm has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. The institution of Dr. Schwamm has received research support from NINDS. The institution of Dr. Schwamm has received research support from PCORI. Dr. Schwamm has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Schwamm has received publishing royalties from a publication relating to health care. Dr. Schwamm has a non-compensated relationship as a Board of directors with American heart association that is relevant to AAN interests or activities.
Natalia S. Rost, MD, MPH, FAAN, FAHA (Massachusetts General Hospital) Dr. Rost has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for 好色先生. Dr. Rost has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.