Jason Vilar, BCCCP, PharmD
AdventHealth Critical Care at Central Florida
Apopka, Florida
Disclosure information not submitted.
James Priano, PharmD
Clinical Pharmacy Specialist - Emergency Medicine
AdventHealth Orlando
Orlando, Florida
Disclosure information not submitted.
Title: Neurointerventional Radiology Outcomes in Patients with Acute Ischemic Stroke
Introduction: Recent updates in the management of acute ischemic stroke caused by large vessel occlusions including neuroendovascular management, has drastically improved functional outcomes. However, clinical outcomes associated with neuroendovascular care using mechanical thrombectomy (MT) combined with intra-arterial (IA) therapies such as alteplase or glycoprotein IIb/IIIa inhibitors are not well-described. This study aims to describe the clinical outcomes of patients who were treated with MT and standard of care (SOC) versus those treated with MT and SOC plus IA therapies.
Methods: This is a retrospective cohort of 191 patients with acute ischemic stroke who were treated with MT within 24 hours of stroke onset between January 1, 2019 and September 30, 2020. The primary endpoint is the percentage of patients with a good clinical outcome measured at 24 hours post MT and discharge. Secondary endpoints such as Modified Rankin Scale, Modified Thrombolysis in Cerebral Infarction, evidence of symptomatic intracranial hemorrhage (sICH), in-hospital and ICU length of stay (LOS), in-hospital mortality, ambulatory status at discharge, and discharge disposition were also collected.
Results: There were 116 patients included in the final analysis based on exclusion criteria. Of the 116 patients 99 received MT and SOC, while 17 received MT, SOC and IA therapies. Baseline characteristics were similar between groups. Patients were considered to have moderate to severe stroke based on the NIHSS (17 vs. 18, p = 0.082). There was no difference in the primary outcome at 24 hours post MT (74% vs 59%, p = 0.247) and at discharge (76% vs 71%, p = 0.762). There was no difference in sICH (31% vs 53%, p = 0.084), in hospital LOS (7d vs 13d, p = 0.115) and in hospital mortality (7% vs 6%, p = 0.859). Patients in the IA group were in the ICU longer (2d vs 3d, p = 0.04)
Conclusions: In acute ischemic strokes IA therapies combined with MT and SOC did not lead to an improved functional outcome score when compared to MT and SOC alone. There also was no statistical difference in sICH. In patients requiring salvage therapy IA therapies may be an option however further research is required to determine the safety of such intervention.