O-018 Thrombectomy outcomes in patients with low aspects treated within 24 hours of symptoms onset: insights from STAR (2021)

<h3>Introduction</h3> Outcomes of mechanical thrombectomy (MT) depends largely of achieving reperfusion of a salvageable brain tissue. Patients with poor baseline images were excluded from most clinical trials so the data about their outcomes remain scarce and whether these patients could still benefit from MT remains unknown. In this study, we aim to investigate the safety and efficacy of EVT in patients with large vessel occlusion and large core infarct. <h3>Methods</h3> The Stroke Thrombectomy and Aneurysm Registry (STAR) that combined the prospectively maintained databases of 28 thrombectomy-capable stroke centers in the US, Europe, and Asia was interrogated. We included thrombectomy patient presenting with emergent large vessel occlusion within 24 hours and with a large core infarct as defined by Alberta Stroke Program Early CT Score (ASPECTS) &lt; 6. Patients presenting within 6 hours of last known normal (LKN) were considered in the early window and patients presenting after 6 hours were considered in the late window. 90-day outcomes were assessed using modified Rankin scale (mRS)We used a logistic regression model to assess the factors associated with good 90-day outcome in patients in the early and late thrombectomy window. <h3>Results</h3> 144 patients were included in this study (table). Median age was 69 and 92 (64%) patients were treated in the early MT window. M1 was the most common site of occlusion (51.4%) and ADAPT was used in 34.7%. Median admission NIHSS was 17.5. Successful recanalization (TICI&gt;2b) was achieved in 84.7% and median procedure time was 54 minutes. sICH hemorrhage was observed in 22 (15.3%). Regarding 90-day outcome, median mRS was 4, favorable outcome (mRS 0-2) was observed in 41 patients (28.5%) and mortality occurred in in 59 (41%). There was no difference in 90-day functional outcome between patients in early and late windows. In patients presenting in the early window, age (aOR=0.905, p=0.0002; CI=0.858-0.954) and baseline NIHSS (aOR=0.909, p=0.0423; CI=0.829-0.997) were independently associated with 90-day outcome. In patients presenting in the late window, only age (aOR=0.934, p=0.0069; CI=0.888-0.981) was independently associated with good outcome. <h3>Conclusion</h3> More than one in four patients presenting with ASPECTS&lt;6 may achieve functional independence at 90-day following MT. Patient age remained the main predictors of 90-day outcome in patients with low ASPECTS in both late and early window. <h3>Disclosures</h3> <b>Z. Hubbard:</b> None. <b>G. Porto:</b> None. <b>S. Al Kasab:</b> None. <b>E. Almallouhi:</b> None. <b>A. Alawieh:</b> None. <b>R. De Leacy:</b> None. <b>D. Raper:</b> None. <b>A. Rai:</b> None. <b>T. Dumont:</b> None. <b>S. Wolfe:</b> None. <b>P. Jabbour:</b> None. <b>C. Ogilvy:</b> None. <b>P. Park:</b> None. <b>M. Levitt:</b> None. <b>A. Polifka:</b> None. <b>R. Crowley:</b> None. <b>A. Arthur:</b> None. <b>J. Osbun:</b> None. <b>R. Crosa:</b> None. <b>I. Maier:</b> None. <b>K. Burchiel:</b> None. <b>J. Grossberg:</b> None. <b>S. Chowdhry:</b> None. <b>M. Mokin:</b> None. <b>C. Matouk:</b> None. <b>R. Williamson:</b> None. <b>A. Yoo:</b> None. <b>J. Mascitelli:</b> None. <b>P. Kan:</b> None. <b>M. Psychogios:</b> None. <b>R. Starke:</b> None. <b>A. Spiotta:</b> None.