Abstract Number ‐ 170: Trends for Endovascular Mechanical Thrombectomy versus Intravenous Tissue Plasminogen Activator for Vertebrobasilar Stroke Treatment

Introduction Acute vertebrobasilar artery occlusion (VBAO) represents approximately 20% of patients presenting with acute ischemic stroke. The occlusion is caused by an embolus or underlying atherosclerotic disease plaque rupture forming an acute thrombus. Without treatment, VBAO’s mortality nears 80–90%, thus, effective and timely treatment strategies become paramount in managing the patients. Herein, we analyzed the age difference and outcomes in patients that underwent either Endovascular Mechanical Thrombectomy (MT) or intravenous (IV) tissue plasminogen activator (tPA). Methods National Inpatient Sample (NIS) was queried from years 2016 to 2018 using ICD‐10 diagnosis and procedure codes for occlusion or thrombosis of vertebral artery or basilar artery (I63.21, I63.22, I63.01, and I63.02), IV tPA (3E03317), and MT (03CG3ZZ, 03CG3Z6, 03CG3Z7, 03CG4Z6, 03CG4ZZ). Chi‐square test and was used for statistical analysis. Results From 2016 to 2018, there were 37,310 patients admitted with vertebrobasilar stroke. Out of these, IV tPA was administered in 2,530 (6.8%) admissions, whereas MT was done in 2,330 (6.2%) admissions. IV tPA was used significantly more than MT in age groups 65–84 and > = 85 years. MT was used significantly more than IV tPA in age groups 18–44 and 45–64 (Figure 1). There was no significant difference in their use between men and women. In large hospitals, MT was more common than IV tPA (8.1% vs 7%, p < 0.0001), and in small hospitals, IV tPA usage was significantly higher (3.8% vs 2%, p < 0.0001). All‐cause mortality rate was significantly higher in MT than IV tPA admissions (16.8% vs 8.1%, p < 0.0001). There was no significant difference in mean length of stay (LOS) between the two modalities (Figure 1). Conclusions We saw a trend of higher rate of mechcnical thrombectomy in younger age group (18‐64 years) than older, however, no sex difference was noted. All‐cause mortality rate was higher in the mechanical thrombectomy group than intravenous tissue plasminogen activator group. In addition, there was no difference in length of hospital stay

Abstract Number: LBA18 Tissue‐Based Perfusion Imaging in Acute Cerebral Small Vessel Disease Ischemic Stroke

Introduction There is growing evidence for the role of CT perfusion in tissue‐based treatment of acute ischemic stroke (AIS) secondary to large vessel occlusion (LVO). The utility of tissue‐based perfusion imaging in acute cerebral small vessel disease AIS may be low yield with current technology available. The purpose of this study was to evaluate the utility of CT perfusion in identifying small lenticulostriate hypoperfusion in cerebral small vessel disease strokes. Methods Get With The Guidelines database was used for retrospective chart review of patients presenting to our comprehensive stroke center with small vessel disease stroke defined as subcortical or brain stem lacunar infarction < 1.5 cm. Other stroke etiologies were excluded. A tissue‐based grading system was used to identify regions of hypoperfusion ordinally ranging from 0 to 5 (1‐thalamocapsular, 1‐basal ganglia, 2‐internal capsule, 1 caudate). Two board‐certified vascular neurologists independently evaluated CT perfusion maps, and Cohen’s K was used to determine kappa inter‐rater agreement. Lesions were later confirmed with MR diffusion‐weighted imaging. Social science statistics software was used for data analysis. Results From April 2017 to July 2022, out of 563 patients with small vessel disease stroke, 77 patients had CT perfusion. Thirty‐nine subjects were excluded because they did not meet inclusion criteria. Mean age was 67.09 (95% CI 62.82, 71.37), and 10 subjects (31.25%) were female. and presenting NIHSS was 5.28 (95% CI 3.97, 6.58). Baseline characteristics including history of coronary artery disease, atrial fibrillation, diabetes mellitus including hemoglobin A1C, hypertension, hyperlipidemia including LDL, stroke, intracranial hemorrhage, tobacco use, anti‐thrombotic use, presenting systolic blood pressure, presenting blood glucose, last known normal were assessed. Three subjects received IV thrombolytics. All subjects (n = 32) had normal CT perfusion maps (kappa = 1). Conclusions Mismatch was not identified on CT perfusion in all subjects with small vessel disease stroke using conventional CT perfusion map protocols, that could have been useful in potentially guiding therapeutic optimization of hemodynamics. Larger, prospective studies are needed to validate our results