IntroductionASPECTS and penumbral imaging based on CT-perfusion (CTP) are regularly used to guide patient selection for mechanical thrombectomy (MT). Yet, patients with large ischemic core on CTP may ...show no or only minor ischemic changes resulting in a high ASPECTS.AimWe hypothesized two-fold that vessel recanalization in patients with core volume >50 ml but ASPECTS≥6 is associated with better functional outcome and core overestimation.MethodsObservational study analyzing ischemic stroke patients consecutively treated by MT after triage by multimodal-CT. Primary endpoint was the rate of functional independence at 90-days (mRS≤2). Secondary end point was core overestimation, which was considered when CTP-derived core was larger than final infarct volume assessed on follow-up. Multivariable logistic regression analysis and prospensity score matching (PSM) were used to assess the association of treatment with functional outcome and core overestimation.ResultsOf 630 patients with ASPECTS≥6, 91 patients (14.4%) had a large ischemic core. Following 1:1 PSM, the treatment effect of recanalization was not different in patients with large core and ASPECTS≥6 (+25.8%,95%CI:16.3–35.4,p<0.001) compared to patients with ASPECTS≥6 and core volume <50 ml (+14.9%,95%CI:5.7–24.1,p=0.002). Recanalization (aOR:3.87,95%CI:1.66–9.00,p=0.002) and higher core volume (aOR:1.04,95%CI:1.02–1.05,p<0.001) were significantly associated with core overestimation.ConclusionIn patients with ASPECTS≥6, core volumes did not significantly modify the treatment effect of recanalization. Reperfusion and higher core volume were significantly associated with core overestimation which may explain the treatment effect of MT for patients with large ischemic core but minor ischemic changes on NECT.Abstract O09/90 Figure 1Abstract O09/90 Figure 2Disclosure of InterestNA.
IntroductionThe European EYMINT tele-observership (e-fellowship) was initially launched in 2020 and has since enrolled 72 neurointerventional fellows. These have live remote access to procedures ...performed by individually assigned specialists (mentors) at geographically distant high volume neurointerventional centers.Aim of Study1) Assessment of situational awareness during remote attendance of neurointerventional procedures. 2) Assessment of learning progress among participants.MethodsProspective evaluation of telestreamed cases from 2020 to 2023 via anonymous questionnaires for trainees and mentors.ResultsFrom 06/2020 to 04/2023 a total of 498 cases were transmitted to fellows using telestream technology (33% Aneurysm, 29% AVM/DAVF, 27% Ischemic Stroke). Although not being physically present, a high level of situational awareness for the procedure (levels 4+5 on a Lickert scale from 1–5) was reported by 81.9% of fellows. The impact of the fellowship on knowledge improvement during neurointerventional training was reported to be large by 55% of participants. Technical knowledge (handling of devices) and procedural knowledge (sequence of interventional steps) were equally described to be the areas of particular improvement. Remote attendance of complex aneurysm cases (intrasaccular devices, flow diversion) seemed to deliver most value in terms of learning progress. Nevertheless, some participants stated more value from a different perspective on a common procedure, i.e. a thrombectomy.ConclusionTele-observerships may supplement neurointerventional hands-on training in particular of low-frequency high-complexity procedures.Disclosure of InterestMatthias Bechstein: Nothing to discloseHelena Guerreiro: Nothing to discloseTeresa Nawka: Nothing to discloseVladimir Kalousek: Nothing to discloseJens Fiehler: Nothing to discloseUta Hanning: Nothing to disclose.
IntroductionFor large vessel occlusions, 24h NIHSS was described as most accurate early clinical predictor of functional outcome in acute stroke patients. M2 occlusions are characterized by more ...distal and smaller infarct cores, early clinical surrogates of functional outcome might differ.Aim of StudyTo investigate early clinical surrogates for long-term independency of patients treated with mechanical thrombectomy for M2 occlusion stroke in comparison to patients with M1 occlusion stroke.MethodsAll patients enrolled in the German Stroke Registry-Endovascular Treatment (05/2015–12/2021; N=13082) were screened for anterior circulation stroke. Receiver-operating-characteristics(ROC)-curve analyses and area-under-the-curve(AUC) were used to evaluate the performance of admission NIHSS, 24h NIHSS and NIHSS percentage and absolute change to predict functional outcome at 90d. Excellent and good outcome were defined as modified Rankin Scale(mRS) 0–1 and 0–2, respectively.Results1268 patients with M2 and 2749 patients with M1 occlusion were included. For both cohorts, 24h NIHSS had the highest discriminative ability to predict excellent functional outcome with AUC=0.86(95%CI=0.84–0.88) for M2 and AUC=0.86(0.84–0.88) for M1 occlusions. Optimal cutoffs were NIHSS≤7 and NIHSS≤8, respectively. Good long-term functional outcome was predicted with AUC=0.86(0.85–0.88) for M2 and AUC=0.86(0.85–0.88) for M1 occlusions with optimal cut-offs NIHSS≤8 and NIHSS≤9, respectively.Conclusion24h NIHSS was identified as best surrogate for long-term functional outcome after thrombectomy for patients with M1 and M2 occlusion, while optimal cut-offs to predict good and excellent outcome were 1 NIHSS-point higher in M2 occlusions compared to M1 occlusions.Disclosure of InterestHK has financial interest in Eppdata GmbH.GT received fees as consultant and lecturer from Acandis, Alexion, Amarin, Boehringer Ingelheim, Bayer, BMS/Pfizer, Daiichii Sankyo and Portola. He serves in the board of the TEA Stroke Study and of ESO.JF is consultant for Cerenovus, Medtronic, Microvention, Penumbra, Phenox, Roche, Stryker and Tonbridge. He is stock holder of Tegus Medical, Eppdata and Vastrax. He serves as Associate Editor at JNIS.All other authors have nothing to disclose.
IntroductionFirst-pass(FP)-recanalization has been shown to improve outcome in patients with ischemic stroke undergoing mechanical thrombectomy(MT). Data also suggests that FP-recanalization is more ...often associated with complete reperfusion TICI=3 than with TICI=2b. Independently, it was shown that TICI=3 significantly improves functional outcome after mechanical thrombectomyAim of StudyTo evaluate whether early recanalization or complete recanalization TICI=3 are the determinants of improved outcome observed after FP-recanalization.MethodsAll patients prospectively enrolled in the German Stroke Registry-ET (05/2015–12/2021;N=13082) were screened. Inclusion criteria were anterior circulation stroke and successful recanalization TICI≥2b. Good functional outcome was defined as 90d modified Rankin Scale(mRS)≤2. Mediation analysis was performed to evaluate how much of the FP-related improvement in functional outcome is explained by complete reperfusion TICI=3.Results2589 patients were included, 1170(47%) had successful FP recanalization, 797(68% of FP-cases) with TICI=3. FP-recanalization was associated with higher rate of good functional outcome compared to multi-pass with 49.2% vs 37.6%. Mediation analysis suggests that FP-recanalization increases probability of good outcome by 9.6 percentage points vs. multi-pass recanalization. 12.8% (95%CI:7.6%-23%) of this effect was explained by TICI=3 recanalization whereas 87.2% (77%-92%) are explained by other factors associated with FP- recanalization.ConclusionOnly 13% of the FP-related improvement in functional outcome is explained by higher rates of complete recanalization, suggesting significant importance of early recanalization and low number of MT maneuvers. Results may improve the understanding of the importance of FP-reperfusion vs. early TICI=3 and may help to optimize MT treatment strategies.Disclosure of InterestHK has financial interest in Eppdata GmbH.GT received fees as consultant and lecturer from Acandis, Alexion, Amarin, Boehringer Ingelheim, Bayer, BMS/Pfizer, Daiichii Sankyo and Portola. He serves in the board of the TEA Stroke Study and of ESO.JF is consultant for Cerenovus, Medtronic, Microvention, Penumbra, Phenox, Roche, Stryker and Tonbridge. He is stock holder of Tegus Medical, Eppdata and Vastrax. He serves as Associate Editor at JNIS.All other authors have nothing to disclose.
IntroductionDIRECT-SAFE and SWIFT DIRECT did not show noninferiority of mechanical thrombectomy(MT) alone compared with intravenous thrombolysis(IVT) plus MT. However, for isolated M2-occlusions, ...data is scarce.Aim of StudyThis study aims to evaluate safety and efficiency of bridging-IVT+MT compared to MT only in M2-occlusions.MethodsAll patients prospectively enrolled in the German Stroke Registry-ET (05/2015–12/2021; N=13082) were screened for isolated M2-occlusions. Primary endpoint was defined as functional independence(90d mRS≤2), secondary endpoints were excellent outcome(90d mRS≤1), increase in mRS-points pre-stroke to 90d and successful reperfusion(TICI≥2b). Safety outcomes were intracranial hemorrhage(ICH) during treatment and symptomatic intracranial hemorrhage (sICH) at 24h(ECASS II). Propensity-score-matched cohorts (age, pre-stroke-mRS, NHISS-admission, ASPECTS, time symptom onset to admission) of patients receiving IVT+MT vs. MT alone were compared using standard descriptive statistics and multivariable regression.ResultsN=618 matched cases were analyzed (IVT+MT:309; MT:309). No differences were found in age (77y), pre-stroke-mRS (0.8), NIHSS-admission (10.8) and recanalization success (TICI≥2b 84%). IVT was not associated with higher probability of functional independence, however, 90d-mRS (2.9 vs. 3.4, p<0.01) and pre-stroke to 90d-mRS increase (+2.1 vs. +2.6, p<0.01) was lower in patients receiving MT+IVT. No significant differences were found for ICH (MT:4.9%, MT+IVT:6.1%, p=0.481) and sICH (MT:3.9%, MT+IVT:2.9%, p=0.506).ConclusionIn M2-occlusions, MT+IVT was not associated with increased risk of sICH. Patients receiving MT+IVT had lower 90d-mRS and a lower increase in mRS pre-stroke to 90d. However, probability of functional independence and rates of successful recanalization were similar compared to matched controls.Disclosure of InterestHK has financial interest in Eppdata GmbH.GT received fees as consultant and lecturer from Acandis, Alexion, Amarin, Boehringer Ingelheim, Bayer, BMS/Pfizer, Daiichii Sankyo and Portola. He serves in the board of the TEA Stroke Study and of ESO.JF is consultant for Cerenovus, Medtronic, Microvention, Penumbra, Phenox, Roche, Stryker and Tonbridge. He is stock holder of Tegus Medical, Eppdata and Vastrax. He serves as Associate Editor at JNIS.All other authors have nothing to disclose.
