Abstract Details

Title Unexpected Neurological Outcomes After Successful Mechanical Thrombectomy in Acute Ischemic Stroke: ASPECTS Decay

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-016

Objective This study aims to investigate factors contributing to lower Alberta Stroke Program Early CT Scores (ASPECTS) in follow-up imaging, despite initial high ASPECTS and successful mechanical thrombectomy in large vessel occlusion (LVO) stroke patients

Background Mechanical thrombectomy (MT) has become one of the leading strategies for managing acute ischemic stroke caused by LVO, significantly improving patient outcomes. The ASPECTS helps select MT candidates, and the extended Thrombolysis in Cerebral Infarction (eTICI) scale measures procedural success, with eTICI 2b or higher indicating success. However, some patients exhibit a lower ASPECTS in 24-hour follow-up imaging, raising questions about the factors behind this unexpected decline, despite successful MT

Design/Methods This retrospective study used prospectively collected data from the Society of Vascular and Interventional Neurology (SVIN) registry. We included LVO patients treated between January 2020 and December 2023. ASPECTS at admission and 24-hour follow-up were recorded, along with eTICI scores and other factors such as age, blood glucose, number of passes, collateral status, time from last known well (LKW) to recanalization, comorbidities, and post-thrombectomy follow-up. We defined ASPECTS-d as the difference between admission and 24-hour ASPECTS and used descriptive statistics and multivariable logistic regression to investigate predictors of higher ASPECTS-d

Results Of 394 patients, 287 had a ASPECTS-d >1, and 107 had ASPECTS-d = 0. Multivariable regression showed that longer LKW-to-recanalization time (OR 1.001, p=0.029) was significantly associated with higher ASPECTS-d, independently of age, IVT, AF, HTN, DM, and prior Aspirine. Higher number of passes showed a non-significant trend (OR 1.21, p=0.064)

Conclusions The results of this study suggest that delays in recanalization and an increased number of passes during MT may contribute to ASPECTS decay. However, yet-to-be-determined factors, as well as interactions between other potential risk factors, require further exploration.

Authors/Disclosures
Leonardo Cruz, MD (University of Iowa) PRESENTER	Dr. Cruz has nothing to disclose.
Milagros Galecio-Castillo, MD	Dr. Galecio-Castillo has nothing to disclose.
Anderson Brito-Alvarado, MD	Dr. Brito-Alvarado has nothing to disclose.
Piyush Kalakoti, MBBS	Dr. Kalakoti has nothing to disclose.
Jenny Huynh	Ms. Huynh has nothing to disclose.
Santiago Ortega Gutierrez, MD (University of Iowa)	Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for stryker. Dr. Ortega Gutierrez has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for medtronic. Dr. Ortega Gutierrez has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. The institution of Dr. Ortega Gutierrez has received research support from stryker. The institution of Dr. Ortega Gutierrez has received research support from Medtronic. The institution of Dr. Ortega Gutierrez has received research support from Methinks. The institution of Dr. Ortega Gutierrez has received research support from NIH. The institution of Dr. Ortega Gutierrez has received research support from PCORI.

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