Abstract Details

Title Disposition to Acute Rehabilitation Enhances Potential for Good Clinical Outcome after Endovascular Stroke Reperfusion Therapy

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P03 - (-)

Poster/Presentation
Number 174

Objective

Background BACKGROUND: Endovascular reperfusion reduces ischemic stroke volume; however treatment effect on outcomes may be diluted by subsequent care and discharge disposition.

Design/Methods DESIGN/METHODS: Subjects were identified from a prospective database tracking clinical outcomes of patients treated with endovascular reperfusion from a single primary care stroke center. Data included discharge disposition, NIHSS, THRIVE, HIAT-2, & APACHE II scores, symptomatic hemorrhage, and successful reperfusion. Good clinical outcome was defined by 90 day modified Rankin scores (mRS). A binary logistic regression model was used to determine if placement to IRF versus a SNF led to differing clinical outcomes.

Results RESULTS: 207 subjects were included in the analyis; mean age was 66±14 and median NIHSS was 20. Discharge dispositions included: 35(19.8%)home, 38(21.5%)IRF, 47(26.6%)SNF and 57(32.3%) died/went to hospice. The 85 patients discharged to SNF or IRF were further analyzed to determine predictors of mRS 0-2 at 90 days. Only 26% of patients discharged to SNF compared to 50% to IRF achieved a good clinical outcome (p-value <0.03). Modified APACHE II, NIHSS, THRIVE, & HIAT-2 scores were not different between the two groups. In binary logistic regression modeling, after adjusting for age, infarct volume, pre-treatment ASPECT & NIHSS scores, and modified APACHE II score, disposition to SNF was significantly associated with a lower probability of achieving a mRS of 0-2 at 90 days, OR 3.31(95%CI 1.06-9.62, p<0.04).

Conclusions CONCLUSIONS: In this study, subjects discharged to SNF & IRF after thrombectomy have similar medical & neurological severity at admission and similar final infarct volumes at discharge. Despite these similarities, patients discharged to SNF had a significantly lower probability of achieving a good neurological outcome.

Authors/Disclosures
Samir Belagaje, MD, FAAN (Dept of Neurology Emory University) PRESENTER	Dr. Belagaje has nothing to disclose.
Vishal Patel	No disclosure on file
Chung-Huan J. Sun, MD	No disclosure on file
Andrew B. Lassman, MD, FAAN (Columbia University Irving Medical Center)	No disclosure on file
	No disclosure on file
Tommy T. Thomas, MD, PhD (Emory University)	Dr. Thomas has nothing to disclose.
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.
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.
Rishi Gupta, MD	No disclosure on file

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