Abstract Details

Title Systematic Characterization of Large Vessel Occlusion Strokes at a CSC

Topic General Neurology

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-021

Objective Describe clinical and radiographic characteristics of LVO Strokes

Background

Endovascular thrombectomy (EVT) for the treatment of acute ischemic stroke (AIS) has significant implications for triage, workup and management of patients with a large vessel occlusion (LVO). A better understanding of clinical and radiographic characteristics of this patient population is critical in resource allocation and clinical practice.

Design/Methods

Retrospective chart review of consecutive acute ischemic stroke discharges was performed at a single comprehensive stroke center between November 2014 and February 2017. Demographic (age, sex), clinical (stroke severity, time from stroke onset and mode of presentation) and radiological imaging data (occlusion location, stroke burden- ischemic core volume and ASPECTS score) were collected and analyzed.

Results A total of 2667 acute ischemic strokes were discharged during the study period. Mean age was 71 ±14 years. 30% were 80 years of age or older and 42% were males. 81% of the 1080 patients presented in the early time window (0-6 hours) arrived within 4.5-hour window of IV tPA eligibility. 24% (n=639) harbored an acute intracranial vessel occlusion of the anterior circulation: Location of LVO was as follows: 44% (n=281) MCA-M1, 18% (n=115) ICA, 17% (n=108) MCA-M2, 17% (n=108) Basilar/ Vertebral Artery and 4% (n=27) MCA-M3/ ACA/ PCA occlusions. 17% of AIS due to ICA/MCA occlusions had an ASPECTS ≤5 and 17% had mRS >2 at baseline. Distribution of NIHSS score in AIS due to ICA/MCA occlusions was- <10 (17%), 10-19 (46%) and ≥20 (37%).

Conclusions

This single center analysis of AIS patients with LVO demonstrates that a majority of patients present beyond 6 hours to a CSC. In patients with a proximal LVO, less than 1 in 5 have an ASPECT of 0-5 on presentation. Distal anterior circulation occlusions and posterior circulation occlusions account for 38% of LVO. Further studies are needed to understand the best management for this population of patients.

Authors/Disclosures
Shashvat Desai, MD (University of Pittsburgh Medical Center) PRESENTER	Dr. Desai has nothing to disclose.
Marcelo Rocha, MD, PhD (UPMC)	The institution of Dr. Rocha has received research support from NIH.
Bradley Molyneaux, MD, PhD (Brigham and Women's Hospital)	Dr. Molyneaux has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Molyneaux has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Billing, Cochran, Lyles, Mauro and Ramsey. The institution of Dr. Molyneaux has received research support from NIH. Dr. Molyneaux has received publishing royalties from a publication relating to health care.
Matthew T. Starr, MD (University of Pittsburgh Medical Center)	Dr. Starr has nothing to disclose.
Tudor G. Jovin, MD (Cooper University Healthcare)	Dr. Jovin has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Jovin has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Contego Medical. Dr. Jovin has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Several law firms. Dr. Jovin has stock in Corindus. Dr. Jovin has stock in Methinks. Dr. Jovin has stock in Viz.ai. Dr. Jovin has stock in Route92. Dr. Jovin has stock in FreeOx Biotech. Dr. Jovin has stock in Galaxy. Dr. Jovin has stock in Kandu. The institution of Dr. Jovin has received research support from Stryker. The institution of Dr. Jovin has received research support from Medtronic.
Ashutosh P. Jadhav, MD, FAAN (Barrow Neurological Institute)	Dr. Jadhav has nothing to disclose.

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