International Experience of Mechanical Thrombectomy During the COVID-19 Pandemic: Insights from STAR and ENRG

Background: In response to the COVID-19 pandemic, many centers altered stroke triage protocols for the protection of their providers. However, the effect of workflow changes on stroke patients receiving mechanical thrombectomy (MT) has not been systematically studied. Methods: A prospective international study was launched at the initiation of the COVID-19 pandemic. All included centers participated in the Stroke Thrombectomy and Aneurysm Registry (STAR) and Endovascular Neurosurgery Research Group (ENRG). Data was collected during the peak months of the COVID-19 surge at each site. Collected data included patient and disease characteristics. A generalized linear model with logit link function was used to estimate the effect of general anesthesia (GA) on in-hospital mortality and discharge outcome controlling for confounders. Results: 458 patients and 28 centers were included from North America, South America, and Europe. Five centers were in high-COVID burden counties (HCC) in which 9/104 (8.7%) of patients were positive for COVID-19 compared with 4/354 (1.1%) in low-COVID burden counties (LCC) (P<0.001). 241 patients underwent pre-procedure GA. Compared with patients treated awake, GA patients had longer door to reperfusion time (138 vs 100 min, P=<0.001). On multivariate analysis, GA was associated with higher probability of in-hospital mortality (RR 1.871, P=0.029) and lower probability of functional independence at discharge (RR 0.53, P=0.015). Conclusion: We observed a low rate of COVID-19 infection among stroke patients undergoing MT in LCC. Overall, more than half of the patients underwent intubation prior to MT, leading to prolonged door to reperfusion time, higher in-hospital mortality, and lower likelihood of functional independence at discharge.info:eu-repo/semantics/publishedVersio

O-025 Outcomes of rescue endovascular treatment of acute ischemic stroke in patients with underlying intracranial atherosclerosis – insights from star registry

IntroductionMechanical Thrombectomy (MT) is the standard of care for patients presenting with emergent large vessel occlusion (ELVO) with salvageable tissue. A subgroup of ELVO is refractory to reperfusion due to underlying intracranial atherosclerosis (ICAS), often requiring rescue therapy with balloon angioplasty, stenting or both. Whether such rescue therapy is safe and effective remains to be established. The purpose of this study is to investigate the safety, efficacy, and long-term outcomes of MT for ELVO related ICAS.MethodsWe queried the databases of 11 thrombectomy-capable centers in the US and Europe included in STAR (Stroke Thrombectomy and Aneurysm Registry). In this analysis, we included patients who underwent rescue therapy (balloon angioplasty and/or stenting) in the setting of ELVO due to underlying ICAS. A matched sample was produced by matching on the variables of age, admission NIHSS, and location of the occlusion.ResultsOut of 2827 thrombectomy patients included in STAR at the time of this analysis, 190 patients required rescue therapy for ELVO with underlying ICAS. Balloon angioplasty was performed on 116 patients, and 113 patients had intracranial stenting. On multivariate analysis, after controlling for age, sex, race, hypertension, diabetes, prior stroke, NIHSS on admission and location of occlusion; compared to angioplasty alone, or stenting alone, combination therapy with angioplasty and stenting was associated with higher odds of favorable long-term functional outcome (mRS 0–2) (OR 4.404, 95% CI 1.318–9.712; P=0.021).in the matched analysis, 161 rescue therapy patients matched to a similar number of controls. There was no difference in age, race, sex, rate of IV tPA administration, ASPECTS score, or onset to groin time. Successful first attempt rate was lower (52% vs. 22%, p=0.001) and procedural time was longer in the rescue therapy group (47 min vs. 31 min, p≤0.001). There was no difference in symptomatic intracranial hemorrhage (7.5% vs. 5.6%, p=0.49), or favorable long term functional outcome (modified Rankin scale 0–2) (42.2% vs. 50.9%, p=0.118) between patients in the rescue therapy and control groups.Abstract O-025 Table 1Baseline features, procedural metrics and outcomes in the 2 treatment groups (rescue theraly vs. matched control)ConclusionIn patients with ELVO with underlying ICAS requiring rescue therapy, despite longer procedural time and lower rate of first pass revascularization, rescue therapy appears to be safe with similar rate of favorable long-term functional outcomes compared to patients with large vessel occlusion from embolic source.Disclosures S. Al Kasab: None. E. Almallouhi: None. I. Maier: None. A. Arthur: None. J. Kim: None. R. De Leacy: None. A. Rai: None. S. Keyrouz: None. K. Fargen: None. T. Dumont: None. P. Kan: None. R. Starke: None. A. Spiotta: None

Early Postmarket Results with EmboTrap II Stent Retriever for Mechanical Thrombectomy: A Multicenter Experience

Background and purpose: EmboTrap II is a novel stent retriever with a dual-layer design and distal mesh designed for acute ischemic stroke emergent large-vessel occlusions. We present the first postmarket prospective multicenter experience with the EmboTrap II stent retriever. Materials and methods: A prospective registry of patients treated with EmboTrap II at 7 centers following FDA approval was maintained with baseline patient characteristics, treatment details, and clinical/radiographic follow-up. Results: Seventy patients were treated with EmboTrap II (mean age, 69.9 years; 48.6% women). Intravenous thrombolysis was given in 34.3%, and emergent large-vessel occlusions were located in the ICA (n = 18), M1 (n = 38), M2 or M3 (n = 13), and basilar artery (n = 1). The 5 × 33 mm device was used in 88% of cases. TICI ≥ 2b recanalization was achieved in 95.7% (82.3% in EmboTrap II-only cases), and first-pass efficacy was achieved in 35.7%. The NIHSS score improved from a preoperative average of 16.3 to 12.1 postprocedure and to 10.5 at discharge. An average of 2.5 [SD, 1.8] passes was recorded per treatment, including non-EmboTrap attempts. Definitive treatment was performed with an alternative device (aspiration or stent retriever) in 9 cases (12.9%). Some hemorrhagic conversion was noted in 22.9% of cases, of which 4.3% were symptomatic. There were no device-related complications. Conclusions: Initial postmarket results with the EmboTrap II stent retriever are favorable and comparable with those of other commercially available stent retrievers. Compared with EmboTrap II, the first-generation EmboTrap may have a higher first-pass efficacy; however, data are limited by retrospective case analysis, incomplete clinical follow-up, and small sample size, necessitating future trials