Abstract Details

Title Should Acute Ischemic Stroke Patients with Very High National Institutes of Health Stroke Scale Scores Undergo Pre-Procedure Intubation Prior to Endovascular Treatment?

Topic Interventional Neurology

Presentation(s) P07 - (-)

Poster/Presentation
Number 263

Objective

Background BACKGROUND: Due to higher rates of poor outcomes among endovascular procedures performed under general anesthesia, it has been proposed that only acute ischemic stroke patients with very high baseline NIHSS score undergo pre-procedural intubation and mechanical ventilation.

Design/Methods DESIGN/METHODS: All endovascular treated acute ischemic stroke patients identified through a prospective database maintained from two comprehensive stroke centers. Patients' clinical characteristics, type of sedation, pre-procedural intubation status, rates of poor outcome at discharge (modified Rankin score [mRS] of >3) and intracerebral hemorrhage (ICH) were obtained and analyzed. The rates of unexpected intubation in patients undergoing procedure without pre-procedural intubation were ascertained.

Results RESULTS: Among the total of 93 patients (mean age 68.5 ± 16.4) with NIHSS score > 20, 61% (57 patients, 49% men) underwent endovascular procedure after pre-procedural intubation. Among the 57 patients who underwent the procedure without pre-procedural intubation, the rates of unexpected intubation secondary to intra-procedural complication was 6 (11%) of 57 patients. The mean time interval between CT scan to intiation of angiographic procedure was significantly greater among patients who underwent pre-procedural intubation (134±34 versus 170±53 minutes, p<0.001). The risk of post-procedure ICH (odds ratio [OR] 0.3, 95% confidence interval [CI] 0.1-0.8, p=0.01) and in-hospital mortality [OR 0.1, 95% CI 0.07-0.3, p<0.0001] were significantly lower among patients who did not undergo pre-procedural intubation, after adjusting for potential confounders. The rates of poor outcomes at discharge were significantly lower among those patients who underwent the procedure without pre-procedural intubation [OR 0.3, 95% CI 0.1-0.6, p=0.001].

Conclusions CONCLUSIONS: Despite the risk of unexpected intubation secondary to intra-procedural complication, patients with admission NIHSS score>20 who undergo endovascular treatment without pre-procedural intubation have a decreased risk of poor outcomes, ICH and death.

Authors/Disclosures
PRESENTER	No disclosure on file
Katy Eichinger, PhD, PT, DPT, NCS (University of Rochester)	Dr. Eichinger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Fulcrum. Dr. Eichinger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Avidity. Dr. Eichinger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for DyneTherapeutic. Dr. Eichinger has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Roche. Dr. Eichinger has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TRiNDS. The institution of Dr. Eichinger has received research support from Charcot Marie Tooth Association. The institution of Dr. Eichinger has received research support from Muscular Dystrophy Association. Dr. Eichinger has received intellectual property interests from a discovery or technology relating to health care.
Ameer Hassan, DO (Valley Baptist Medical Center)	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.
Wondwossen G. Tekle, MD	Dr. Tekle has nothing to disclose.
Basit Rahim, MD (Virginia Commonwealth University Health System)	No disclosure on file
Saqib A. Chaudhry, MD	Dr. Chaudhry 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.

��ɫ��

��ɫ��