Abstract TP17: Patients Treated With Endovascular Treatment Outside Guidelines


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Abstract

Backgroud: The number of Endovascular treatments (EVT) in stroke is increasing rapidly after the publication of the positive trials. Generally, EVT is recommended in anterior circulation large vessel stroke in a 6 hour time window in patients who are independent (modified Rankin scale 2 or less) and if the infarct is not too large (ASPECTS > 4 or diffusion weighted imaging lesion volume <70 cc).Methods: GOLIATH (General Or Local anesthesia in Intra Arterial THerapy) is a study which is testing whether conscious sedation (CS) or general anesthesia (GA) should be recommended during EVT. The inclusion criteria for GOLIATH include those mentioned above and also, patients must have an MRI scan because the primary outcome measure is infarct growth from baseline to 48-72 hours after EVT as measured on diffusion weighted imaging. Included patients are randomized between GA and CS. We have also captured screen failures (i.e., patients who did not fulfil inclusion criteria but who underwent EVT anyway). We compared the number of patients treated in GOLIATH with the number of screen failures from study initiation in March 2015 to August 2016.Results: Eighty-seven patients have been enrolled in GOLIATH. In the same period, 85 patients have been treated with EVT outside of GOLIATH. The reasons for screen failure were: Posterior circulation stroke: 20 patients NIHSS <10: 18 patients Groin puncture > 6 hours: 16 patients CT scan: 16 patients. (Pacemaker, vomiting, metallic foreign bodies or implants) Intubated at arrival: 5 patients Infarct > 70 cc: 3 patients Baseline mRS >2: 2 patients Age <18 years: 2 patients Withdrew consent: 1 patient Deemed unsafe by anesthesiologist: 2 patientsDiscussion: Among the first 69 patients in GOLIATH, 45 (65%) achieved a good outcome and 6 (9%) were dead at 90 days. Among the first 58 screen failures, 21 (36%) achieved a good outcome and 16 (28%) were dead at 90 days (p=0.002 for good outcome and p=0.01 for death, Chi-square test).Conclusion: A high number of patients are treated outside the general guidelines. Trials are needed to demonstrate effect is these subgroups. (Posterior circulation stroke, NIHSS <10 and groin puncture >6 hours.)

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