Abstract Details

Title Efficacy of Intra-Arterial Therapy in Proximal and Distal M1 Occlusions: A Retrospective Analysis

Topic Interventional Neurology

Presentation(s) S46 - (-)

Poster/Presentation
Number 004

Objective

Background M1 occlusions are associated with low recanalization rates with intravenous therapy. A direct comparison of the efficacy of IAT in proximal and distal M1 occlusions in improving infarct volume and clinical outcome has not been performed.

Design/Methods Patients with M1 occlusions who presented within 6 hours from last-seen-normal between 2009 and 2011 were included. Occlusions at or proximal to the lateral lenticulostriate arteries were classified as "Proximal" and those distal, were termed "Distal". Patients were classified IAT and Control (those receiving intravenous or no therapy) groups. Final infarct volume and occurrence of acceptable outcome (mRS 0-3 at discharge) were compared.

Results 97 patients with M1 occlusions were included (IAT: N=60, Control: N=37). Baseline demographics were similar among the two groups. For all M1 occlusions, median infarct volume was significantly smaller in the IAT group compared to the Control group (38cc vs 110cc, p=0.002). In proximal M1 occlusions, IAT resulted in significantly smaller median infarct volumes as compared to Control (39cc vs 236cc, p<0.0001) whereas no significant difference was observed in infarct volumes in distal M1 occlusions (35cc vs 60cc, p=0.20). Acceptable clinical outcome occurred more frequently in the IA group compared to the Control group for all M1 occlusions (41.7% vs 20.7%, p=0.04) and for proximal M1 occlusions (43.8% vs 9.1%, p=0.04) but not in distal M1 occlusions (39.3% vs 27.8%, p=0.3).

Conclusions As compared to intravenous therapy or no therapy, IAT is more effective in reducing infarct volumes and improving clinical outcomes in patients with M1 occlusions. This benefit seems to be most apparent in proximal M1 occlusions. Larger prospective studies are needed to confirm this finding.

Authors/Disclosures
Srikant Rangaraju, MBBS (Emory University, Atlanta) PRESENTER	Dr. Rangaraju has nothing to disclose.
Kumiko Owada, MD (Wellstar Medical Group)	No disclosure on file
	No disclosure on file
	No disclosure on file
Alireza Noorian, MD	No disclosure on file
	No disclosure on file
Samir Belagaje, MD, FAAN (Dept of Neurology Emory University)	Dr. Belagaje has nothing to disclose.
Aaron M. Anderson, MD (Emory University)	Dr. Anderson has nothing to disclose.
Michael R. Frankel, MD (Emory Univ School of Med/Dept of Neuro)	The institution of Dr. Frankel has received research support from Nico Corporation, Inc.
Fadi B. Nahab, MD	Dr. Nahab has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Legal Consultation. Dr. Nahab has received intellectual property interests from a discovery or technology relating to health care.
Raul G. Nogueira, MD (UPMC Stroke Institute)	Dr. Nogueira has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron (consulting fees) as well as for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze ( stock options). Dr. Nogueira has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law Firms. Dr. Nogueira has received stock or an ownership interest from Viz-AI, Perfuze, Cerebrotech, Reist/Q'Apel Medical, Truvic, and Viseon. The institution of Dr. Nogueira has received research support from Cerenovus.
Rishi Gupta, MD	No disclosure on file

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