E-008 Clinical and Radiographic Outcome of Acute Ischemic Stroke Patient who Presented with Middle Cerebral Artery Occlusion-A Single Center Experience
Authors: Lodi Y , Reddy V , Devasenapathy A , Chou J , Shehades K , Sethi K , Galyon D , Bajwa S 
Published: July 2014

Background

Recent stent retrieval thrombectomy trial demonstrates that better clinical outcome depends on the better recanalization of the occluded artery and better collateral flow may improve outcome. The MCA occlusion may have the least chance for the collateral to contribute. Therefore, prompt and timely recanalization of the MCA may be necessary for better clinical outcome.

Objectives

To identify the recanalization rate of MCA in acute ischemic stroke patients who underwent Solitaire thrombectomy. Also, to determine the clinical outcome and predictor in our series.

Methods

Retrospective review of all consecutive MCA thrombectomy cases from June 2013 to March 28, 2014. Outcomes were measured using NIHSS and mRS. Results: Thirteen patients including 2 failed IV tPA patients with MCA occlusion (right 7, left 6 including one left M3) underwent successful thrombectomy. The median age was 75 (54–88) years old (YO), median NIHSS 17 (8–28) and 6 had unclear/unknown time of symptoms onset. Most of them were female (9/13), 6 were 80 years old of above and 9 had atrial fibrillation (7 not on anticoagulation). The median time to initiate thrombectomy (arrival to IR) from ER arrival was 96.5 min (30–225) and those who received IV tPA contributed the most delay; completion of tPA and follow up CT head. Conscious sedation was given all but two who were intubated due to the initial impact of stroke. Median time to MCA catheterization was 29.8 min (14–45) and all patients received intra-arterial tPA of 2–6 mg except 2 IV tPA cases. Compete recanalization (TICI3) was achieved in 12 cases and partial in 1 (TICI2a) with median time of recanalization from groin puncture of 65.3 min (41–101). Immediate post procedure 10 point improvement of NIHSS was observed in 5 cases including 3 with NIHSS 0. 30 days good outcome (mRS 2 or less) was observed. Two patients who were intubated at presentation died due to the withdrawal of care; first one was an 87 YO woman with NIHSS 28 who didn’t have significant improvement in 24 h, the second case was a 76 YO man with NIHSS 18 and had aortic valve septic emboli as a cause of stroke. Poor outcome (mRS 4) was observed in 3 cases; first case was an 88 years old woman with NIHSS 18, despite TICI3 recanalization sustained internal capsule stroke, the second was a 76 YO woman with NIHSS 24 and failed IV TPA bur TICI3 recanalization and third was a 76 YO woman with NIHSS 18 with partial recanalization. Poor outcome was observed on those who had NIHSS close to 20 or higher and or were intubated at presentation.

Conclusions

Solitaire retrieval device achieves a very high rate of recanalazitation in acute ischemic stroke with MCA occlusion and results in a good clinical outcome. However, a considerable valuable time is still lost from ER arrival to IR arrival. Patients who required endotracheal intubation at presentation and or had NIHSS 20 or higher are associated with poor outcome despite TICI3 recanalization. Further studied are required.

Disclosures

Y. Lodi: None. V. Reddy: None. A. Devasenapathy: None. J. Chou: None. K. Shehades: None. K. Sethi: None. D. Galyon: None. S. Bajwa: None.