Introduction: The advent of mechanical thrombectomy (MT) has become an effective option for the treatment of ischemic stroke in addition to tissue plasminogen activator (tPA). With recent advances in device technology, MT has significantly altered the hospital course and functional outcomes of stroke patients. In this study, we report our 7-year experience with MT and identify predictors of unfavorable functional outcomes and mortality in this patient population.

Methods: We conducted a retrospective study of 310 patients who underwent mechanical thrombectomy for ischemic stroke at Thomas Jefferson University from 2010-2017. We collected data on patient comorbidities, NIHSS on arrival, tPA administration, revascularization outcomes, and functional outcomes on discharge. We performed logistic regression analysis to determine the impact of these variables on clinical outcomes.

Results: In 310 patients, the mean NIHSS on arrival was 16.3 ± 6.45 with 153 (49.4%) of them receiving tPA prior to MT. A TICI score of 3 was achieved in 67.4% of patients, 2B in 12.9%, 2A in 10.6%, 1 in 2.6% and 0 in 6.5%. Hemorrhagic conversion was noted in 53.4% of patients. The median length of ICU and hospital stay was 3.0 and 8.0 days respectively. Multivariate logistic regression analysis showed old age (p=0.012), worse NIHSS (p<0.001), lack of tPA administration (p=0.001), DVT during hospitalization (p=0.002), bacteremia (p=0.018) and TICI scores 0-2A (p<0.001) to be predictors of unfavorable outcome (mRS 4-6) on discharge. Additionally, worse NIHSS (p=0.012), bacteremia in the hospital (p=0.010), and TICI scores 0-2A (p<0.001) were shown to be predictors of inpatient mortality.

Conclusions: As MT extends the treatment window for patients with ischemic stroke, there is a pressing need to understand its implications on the hospital course, hospital-acquired complications, and the outcomes for this patient population. We provide a detailed account of our experience and identify the predictors of unfavorable outcome in our patients.

Patient Care: Our study of the 310 patients with ischemic stroke who underwent mechanical thrombectomy (MT) in the last 7 years delineates the impact MT has had in stroke care and provides an insight into the predictors of poor outcome. It is our hope that our findings will aid in selecting the appropriate candidates for MT as well as avoid the modifiable risk factors of poor outcome.

Learning Objectives: By the conclusion of this session, participants should be able to: 1. Appreciate the impact of mechanical thrombectomy on the hospital course and complications in stroke patients. 2. Identify the predictors of in-hospital mortality in stroke patients after MT. 3. Discuss how to avoid the modifiable predictors of unfavorable outcome.

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