Most patients with large vessel occlusion (LVO) present with high NIHSS, and it has been shown that initial NIHSS is a predictor of outcomes in patient with acute ischemic stroke. The usefulness of neuroendovascular reperfusion has been a controversial topic. The aim of this study was to compare the outcomes of patients with large vessel occlusion strokes treated with neuroendovascular procedures versus those who received conservative treatment, based on a 2-year (2012–2013), single center experience at Ochsner Medical Center in New Orleans, LA.Materials and methods
116 consecutive patients who had both CTA confirmed intracranial LVO and CT-Perfusion data upon arrival to our institution were retrospectively studied. Patients with haemorrhages, tandem lesions, or high grade carotid stenosis were excluded from this analysis. The decision to perform endovascular treatment was made by the vascular neurologist and the neuro-interventionalist based on stroke severity and CTA/Perfusion data. Patients in group 1 (n = 50) underwent endovascular revascularization procedures, while patients in group 2 (n = 66) were treated conservatively (medical management alone or with IV t-PA if within treatment window). Presentation NIHSS, risk factors, mortality, discharge NIHSS, discharge mRS, and follow up mRS were recorded and compared. Onset of symptoms to CT-Perfusion time was also studied.Results
There were no statistical differences in the patient population regarding in age, gender, and risk factors. Also, there was no statistical difference in their presentation/initial NIHSS (17.7 vs. 19.6, p = 0.1236). However, the 2 groups were statistically different in their discharge NIHSS (7.82 vs 18.26, p < 0.00001), discharge mRS (2.42 vs 4.30, p < 0.00001), clinic follow up mRS (2.1 vs 4.12, p < 0.00001), mortality (8% vs 21%, pr = 0.043), and good outcome at discharge (mRS 0–2) (62% vs 14%, pr < 0.00001). There was a statistically significant difference between the groups regarding onset of symptoms to CTA/Perfusion imaging (6h 28 m vs 8 h 26 min, p = 0.0247).Conclusion
Patients who presented with high NIHSS, LVO, and favorable CT-Perfusion data who underwent neuroendovascular reperfusion treatment had significantly better outcomes and decreased mortality in our patient population, despite having similar stroke severity at presentation. This highlights the importance reperfusion, time to treatment, and collateral flow to maintain tissue viability. This study also suggests that CT-Perfusion imaging may be useful to select patients who will benefit from neuroendovascular reperfusion therapy for LVO ischemic stroke.Disclosures
G. Vidal: 3; C; Penumbra Inc, Covidien. J. Milburn: 3; C; Penumbra Inc. A. Pansara: None. B. Jennings: None. V. Sabharwal: None.