Abstract Details

Title Should Aphasic Ischemic Stroke Patients Undergo Pre-Procedural Intubation Prior to Endovascular Treatment?

Topic Interventional Neurology

Presentation(s) S46 - (-)

Poster/Presentation
Number 005

Objective

Background Current practice in the endovascular treatment of acute ischemic stroke includes pre-procedural intubation of aphasic stroke patients to ensure immobility during the procedure. Multiple series have shown that pre-procedural intubation for endovascular procedures leads to a higher rate of poor outcomes mandating a critical review of such ancillary interventions.

Design/Methods All endovascularly treated acute ischemic stroke patients were identified through a prospective database maintained from two comprehensive stroke centers over a 6 year period. Their clinical characteristics, aphasia type, and pre-procedural intubation status were obtained. The rate of unexpected intubation in patients without pre-procedural intubation was ascertained. The rates of poor outcome at discharge (modified Rankin score of greater than 3) and intracerebral hemorrhage (ICH) were compared between those who did or didn't undergo pre-procedural intubation after adjustment for age, gender, admission National Institutes of Health Stroke Scale score, diabetes mellitus, and cigarette smoking.

Results A total of 120 patients with aphasia were identified; 60 (50%) patients intubated prior to revascularization procedure. Among the remaining patients who were not intubated prior to the procedure 21 (35%), 31 (52%), and 8 (13%) had global, expressive, and receptive aphasia, respectively. We identified 6 (10%) patients who required intra-procedural intubation. The odds of any ICH (odds ratio [OR] 6.3, 95% confidence interval [CI] 1.6-24.0) and in-hospital mortality [OR 9.3, 95% CI 2.7-31.0] were significantly higher among those who underwent pre-procedural intubation after adjusting for potential confounders. The rates of favorable outcomes at discharge were significantly lower among patients who underwent pre-procedural intubation [OR 0.1, 95% CI 0.04-0.2].

Conclusions Endovascular revascularization among aphasic, acute ischemic stroke patients should be attempted without intubation, in an effort to reduce intra-procedural complications, such as ICH and death.

Authors/Disclosures
Ameer Hassan, DO (Valley Baptist Medical Center) PRESENTER	Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. Dr. Hassan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Viz.ai. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Hassan has received research support from GE Healthcare.
	No disclosure on file
Haralabos Zacharatos, MD	Dr. Zacharatos has nothing to disclose.
AGADI J. B, MD, FAAN (Apollo Hospital Sheshadripuram, Bangalore)	No disclosure on file
Basit Rahim, MD (Virginia Commonwealth University Health System)	No disclosure on file
Saqib A. Chaudhry, MD	Dr. Chaudhry has nothing to disclose.
Wondwossen G. Tekle, MD	Dr. Tekle has nothing to disclose.
Mikayel Grigoryan, MD (Axon Neurology)	Dr. Grigoryan has nothing to disclose.
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.

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