[P4.212] Downstream Clot Fragment Migration During Endovascular Clot Extraction Adversely Affects Clinical Outcome

James Frey, Carol A. Darbonne, Joni Clark, Allison Tucker, Christina Chapple
Phoenix, AZ, USA


Objective: To assess the effect of downstream migration of clot fragments on clinical outcome in patients treated with endovascular clot extraction.
Background: FDA approval of clot extraction devices is based on technical effectiveness for opening target arteries. Recent randomized trials, however, have failed to demonstrate clinical effectiveness. The role of intraoperative downstream migration of clot fragments has received little attention.
Methods: With IRB approval, we reviewed charts, procedure reports, and images of all patients with M1 occlusions treated with endovascular clot extraction within the past 5 years to compare outcomes in patients with “open” arteries (OP) versus “open with fragments” (OF).
Results: Thirty four patients were treated under general anesthesia (21 Penumbra, 7 Merci retriever, 6 Solitaire). Numbers of patients in each category of final patency were: OP=15, OF=19. No significant intergroup differences were found (means) for age (60), gender (male 55%), symptom onset to treatment (4.71 hours), admission BP (141/82), duration of anesthesia (2.1 hrs), mean BP during anesthesia (132/70), admission NIHSS (13.8), IV-rtPA (70%) pretreatment. OP patients were more likely to have had an atheroembolic than cardiac source (p<0.03), as well as treatment with Solitaire stent (all 6 Solitaire patients were OP). OF were more likely to have had treatment with IV-rtPA (p<0.15), Penumbra (p<0.03), and adjunctive IA-rtPA and abciximab for the target clot (p<0.09). OP had lower discharge NIHSS (6.79 v 13.22; p<.03); greater NIHSS change (-6.21 v -1.89; p<0.03); discharge mRS=0-2 (47% v 21%; p<0.15); discharge mRS=0-3 (53% v 79%; p<0.005); discharged home (33% v 11%; p<0.2). There was one death in each group (NS); one sICH in OF; length of stay was 8 days in both.
Conclusion: Our results strongly suggest an adverse effect of downstream clot fragments. Awareness of this should become part of the approval and post-marketing evaluation of devices.
Category - Cerebrovascular Disease and Interventional Neurology: Acute Stroke Therapy and Endovascular Stroke Cerebrovascular Disease and Interventional Neurology: Treatments

Wednesday, April 30, 2014 7:30 AM

P4: Poster Session IV: Cerebrovascular Disease and Interventional Neurology: Acute Stroke Endovascular (7:30 AM-11:00 AM)

 

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