Abstract Details

Title Experience with Endovascular Therapy in Acute Ischemic Stroke Patients Presenting with Low National Institute of Health Stroke Scale Scores

Topic Cerebrovascular Disease and Interventional Neurology

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

Poster/Presentation
Number 3-031

Objective .

Background Endovascular thrombectomy (ET) is indicated for select patients with large vessel occlusions (LVO) in the anterior circulation (AC) with NIHSS > 6. Safety and efficacy of ET in patients with NIHSS <6 and LVO in the AC is an area of clinical equipoise.

Design/Methods Internal database was queried for patients with admission NIHSS <6 from 1/2015 to 6/2018. NIHSS on presentation, cortical signs, use of ET (on arrival or after clinical decline) and outcomes were collected.

Results 15 patients had LVO in the AC, all had cortical signs; 8 patients were admitted and monitored, 7 patients went directly to ET. Of the 8 monitored patients, 3 (38%) received IVtPA, 6 (75%) underwent rescue ET after clinical decline, all had favorable aspects. Arrival mean NIHSS was 3.3 (4.6), NIHSS at time of ET was 10.6 (7.4). Occlusions were located in the first branch of the middle cerebral artery in 3 cases, with one case each of M2, internal carotid artery (ICA) and tandem occlusion. Five patients (63%) were discharged to acute rehab facility, the remaining 27% were discharged to home, with NIHSS of 7.7 (7.2) on discharge and mRS of 1.75 (1.5) at 90-day follow-up. Of the 7 patients who proceeded directly to ET, arrival NIHSS was 2.3 (2.2), 43% received IVtPA, occlusions were present in the ICA in all patients with tandem MCA occlusions additionally present in 3 (43%). One was discharged to rehab, the remainder (85.8%) were discharged home. Discharge stroke scale (mean 1.4, SD 2.2) approached significance (U=11, p=0.052) compared to the observation group, discharge location (chi 3.6, p=0.58) and discharge mRS did not (U=12, p=0.28).

Conclusions There was a trend toward significance in discharge NIHSS in favor of patients that were taken directly for ET. Further study regarding management of patients with low NIHSS and LVO is merited.

Authors/Disclosures
Nicholas D. Osteraas, MD (Rush University Med Center) PRESENTER	Dr. Osteraas has nothing to disclose.
Daniel M. Schachter, MD (Emory University - Grady Mem Hosp)	Dr. Schachter has nothing to disclose.
James Conners, MD (Rush University Medical Center)	The institution of Dr. Conners has received research support from nih.
Sarah Song, MD, MPH, FAAN (Rush University Medical Center)	Dr. Song has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AAN.
Laurel J. Cherian, MD, FAAN (Rush University Medical Center)	The institution of Dr. Cherian has received research support from NIH.
Alejandro Vargas, MD, MS, FAAN (Rush University Medical Center)	Dr. Vargas has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Bayer U.S. LLC Pharmaceuticals.
Rima Dafer, MD (Rush University Medical Center)	Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Dafer has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Eli Lilly. Dr. Dafer has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Anderson, Rasor, and partners.

��ɫ��

��ɫ��