Abstract Details

Title Mechanical Endovascular Reperfusion Therapy (MER) of Large Vessel Occlusion Stroke (LVO): Comparison of Patient Outcomes Within Versus Outside American Heart / Stroke Association Class of Recommendations 1 (COR 1), Level of Evidence A (LOE A) Guidelines

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P8 - Poster Session 8 (11:45 AM-12:45 PM)

Poster/Presentation
Number 4-014

Objective N/A

Background Indications for MER are rapidly evolving. Real-world patient selection for treatment is complex. Heterogeneity in vascular anatomy, comorbidities, and timing of presentation introduces significant variability in outcomes. Evolving trial data and device technology continue to refine eligibility thresholds. These factors highlight the need for pragmatic, real-world analyses to complement controlled trial results and guide clinical decision-making.

Design/Methods A retrospective study comparing outcomes from patients treated within and outside of the COR 1 LOE A guidelines with MER for LVO was performed. A total of 581 patients, 301 within and 280 outside of the guidelines were analyzed from a comprehensive stroke center. Multivariable regression models for functional outcomes (mRS 0-2) adjusted for age, sex, race, baseline NIHSS, hospital stay, stratified by occlusion site and age were performed. Secondary outcomes including hospital mortality, NIHSS at discharge, mRS-discharge and procedural factors were analyzed.

Results

Treatment within guidelines was associated with better functional outcomes (mRS 0-2) after adjusting for hospital stay length (44.8 % versus 32.9 %, OR 1.52, p=0.042). The benefit of guideline-based treatment diminished with increasing age. There was no significant difference in mortality between groups. Hospital stay was independently associated with functional outcome, yet stay length was similar between the two groups, suggesting that differences in hospital stay did not explain the treatment effect. Age and baseline NIHSS remained significant predictors of outcome. Treatment within guidelines showed significant benefit for M1 MCA occlusions (adjusted OR 2.21, p=0.018). No significant benefit was observed for ICA or multiple/tandem occlusions within the guidelines vs. outside of the guidelines.

Conclusions While MER within guidelines generally provides better outcomes, the benefit varies significantly by occlusion site and age. The similar safety profile between within-guideline and outside-guideline treatment supports consideration of individualized approaches to patient selection, particularly for older patients and those with specific vessel occlusion patterns.

Authors/Disclosures
Ali Ghanem, MD, MS PRESENTER	Dr. Ghanem has nothing to disclose.
Michael Fana, MD (Henry Ford Health System)	Mr. Fana has nothing to disclose.
Pranish Kantak, MD	Dr. Kantak has nothing to disclose.
Jared C. Reese, MD	Dr. Reese has nothing to disclose.
Megan 1. Brady, MPH	Ms. Brady has nothing to disclose.
max K. Kole, MD	Dr. Kole has nothing to disclose.

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