Abstract Details

Title Patterns and Outcomes of Endovascular Therapy in Mild Stroke: A Florida-Puerto Rico Collaboration

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P1 - Poster Session 1 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-029

Objective To evaluate the current practice patterns, safety and outcomes of endovascular therapy (EVT) in patients who present with mild versus moderate/severe ischemic stroke.

Background Patients with mild stroke were largely excluded from the recent randomized trials of endovascular therapy (EVT), which proved the superiority of EVT over best medical management in patients with a large vessel occlusion.

Design/Methods From Jan 2010 to Jan 2018, 127,794 ischemic stroke patients were enrolled in the Florida-Puerto Rico Registry. Patients presenting within 24 hours of symptoms who received EVT were classified into mild (NIHSS ≤ 5) or moderate/severe (NIHSS >5) categories. Differences in clinical characteristics and outcomes were evaluated using multivariable logistic regression.

Results

Among 3,786 EVT patients, median age 73 (IQR=20), 50% women, 446 (12%) had NIHSS≤5. Compared to NIHSS>5, mild patients arrived later to the hospital (median 138 vs. 101 min), were less likely to receive IV tPA (30% vs. 43%), had a longer door to puncture time (median 167 vs. 115 min) and had more distal occlusions (42%, vs. 19.3%). Younger age (OR=2.40, 95% CI 1.60-3.60), prior history of atrial fibrillation (OR=1.83, 95% CI 1.47-2.27), arrival by EMS (OR=2.09, 95% CI 1.45-3.02) and treatment in large hospital (OR=2.86, 95% CI 1.10, 7.39) were independently associated with NIHSS ≤5 . Amongst EVT patients with NIHSS≤5, 76% were discharged home/rehabilitation and 64% were able to ambulate independently at discharge as compared to 53% and 32% of patients with NIHSS>5. Symptomatic ICH occurred in 4% of mild stroke EVT patients and 6.4% in those with NIHSS>5.

Conclusions Despite lack of evidence-based recommendations, 12% of patients receiving EVT in clinical practice have mild neurological presentations. Factors such as age, mode of hospital arrival and hospital size were associated with mild stroke symptoms among EVT patients. Our data suggest safety an overall favorable outcomes in mild stroke receiving EVT.

Authors/Disclosures
Negar Asdaghi, MD (University of Miami) PRESENTER	Dr. Asdaghi has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association.
Dileep R. Yavagal, MD, FAAN (University of Miami Miller School of Medicine)	Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vascular Dynamics. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Guidepoint. The institution of Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for GLG. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Medtronic. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Cerenovus/Johnson & Johnson. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Stryker. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving as a Consultant for Poseydon. Dr. Yavagal has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Athersys. Dr. Yavagal has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gravity Medical Technology. Dr. Yavagal has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Poseydon. Dr. Yavagal has stock in Poseydon. Dr. Yavagal has stock in Galaxy Therapeutics. Dr. Yavagal has stock in Stentrode. Dr. Yavagal has stock in Gravity Medical. Dr. Yavagal has stock in Gravity Medical Technology. Dr. Yavagal has stock in Athersys. Dr. Yavagal has stock in Rapid Medical . Dr. Yavagal has received intellectual property interests from a discovery or technology relating to health care. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Expert with Royal Carribean Cruise Line. Dr. Yavagal has received personal compensation in the range of $5,000-$9,999 for serving as a Medicolegal Consultant with Carnival Cruise Line.
Nicolas Daviaud, PhD (Tisch Multiple Sclerosis Research Center of New York)	Nicolas Daviaud has nothing to disclose.
Nils H. Mueller, MD	No disclosure on file
Nirav Bhatt, MD (University of Pittsburgh)	Dr. Bhatt has nothing to disclose.
Hannah Gardener, ScD (University of Miami)	Ms. Gardener has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Intersocietal Accreditation Commission. Ms. Gardener has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Ellipse Analytics. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Baum Hedlund. Ms. Gardener has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant with A Green Slate Consulting.
	No disclosure on file
Erika T. Marulanda, MD, FAAN (University of Miami)	Dr. Marulanda has nothing to disclose.
Sebastian Koch, MD (University of Miami)	Dr. Koch has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Multiple Legal Matters. Dr. Koch has received stock or an ownership interest from Cerepeutics. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care. Dr. Koch has received intellectual property interests from a discovery or technology relating to health care.
	No disclosure on file
Sofia Oluwole (UM MIller School of Medicine)	No disclosure on file
Ricardo Hanel	No disclosure on file
Brijesh P. Mehta, MD (Memorial Healthcare System)	Dr. Mehta has nothing to disclose.
	No disclosure on file
Ulises L. Nobo, MD (MENONITA CAGUAS)	No disclosure on file
	No disclosure on file
Tatjana Rundek, MD, PhD	The institution of Dr. Rundek has received research support from NIH.
Ralph L. Sacco, MD, MS, FAHA	Dr. Sacco has received personal compensation in the range of $100,000-$499,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association. The institution of Dr. Sacco has received research support from NIH, NINDS, NCATS, NIMHD. The institution of Dr. Sacco has received research support from FL Department of Health. Dr. Sacco has received research support from University of Washington, Seattle. Dr. Sacco has received publishing royalties from a publication relating to health care.
Jose G. Romano, MD, FAAN (University of Miami, Miller School of Medicine)	Dr. Romano has stock in Vycor Medical/NovaVision. The institution of Dr. Romano has received research support from NIH/NINDS. The institution of Dr. Romano has received research support from NIH/NHLBI.

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