Outcomes after Endovascular Therapy in a Population with Mild Acute Ischemic Stroke: A 6.5 Year Observational Cohort Study at a High-Volume Comprehensive Stroke Center (P5.255)

Objective: The objective of this study was to report on patient outcomes in a mAIS population who received IAT.

Background: Despite suffering mild acute ischemic strokes (mAIS, NIHSS≤7), patients have a non-zero risk of morbidity and mortality. Intra-arterial therapy (IAT) is clearly effective in moderate-to-severe AISs, but we have limited knowledge about its efficacy in mAISs.

Design/Methods: We included all adults (≥18) with a mAIS admitted over 6.5 years to a high-volume comprehensive stroke center and who received IAT. Patients were excluded for any contraindication to IAT (n=240). Outcomes were symptomatic ICH (sICH), in-hospital mortality, discharge mRS ≤2, and an improvement in NIHSS at discharge (>2 vs ≤2).

Results: There were 55 patients included in the study. Overall, patients were predominately aged 55–79 years, admitted with an NIHSS 4–7, or had hypertension. 72% of patients either had a cardioembolic or large vessel occlusion (LVO), and 73% arrived either 0h to 4.5h, or >6h to <12h from symptom onset. 15 patients also received IV-tPA. There were no sICHs. Mortality was 9%; a majority of deaths were in males, patients with ages 55–79, LVOs, or an early symptom to arrival time. 42% of patients showed a 3-point improvement in NIHSS at discharge; a majority of these patients were white, aged 55–79, or had hyperlipidemia. Ultimately, 45% were discharged with an mRS ≥2. There were no cerebral artery perforations or groin complications.

Conclusions: These data highlight the safety of IAT in patients with mAIS, mirroring the results seen in recent large RCTs in the non-mAIS population. Patients in our study had a zero risk of sICH, and a mortality rate similar to literature examining IV-tPA administration in patients with mAIS. Furthermore, a large proportion of patients showed a clinically meaningful improvement in NIHSS, or were discharged with a favorable mRS.

Disclosure: Dr. Fanale has nothing to disclose. Dr. Orlando has nothing to disclose. Dr. Frei has received personal compensation for activities with Microvention, Covidien, Stryker, Siemens and Penumbra as a consultant. Dr. Bellon has received personal compensation for activities with Penumbra. Dr. Wagner has received personal compensation for activities with Genentech as a speaker. Dr. Jensen has nothing to disclose. Dr. Bartt has nothing to disclose. Dr. van Vliet has nothing to disclose. Dr. McCarthy has nothing to disclose. Dr. Bar-Or has nothing to disclose.