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  • High-Risk Anatomical Factors to Predict Successful Access and Revascularization in Stroke Intervention

    Final Number:

    Leonardo B. C. Brasiliense MD; Tania Hassanzadeh BS; Whitney S. James; Travis Michael Dumont MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2016 Annual Meeting

    Introduction: In the current era of acute stroke intervention (ASI), successful revascularization is paramount to reduce the ischemic burden of large vessel occlusion and increase the likelihood of improved functional outcomes. Intraprocedural complications, particularly failed revascularization warrants further analysis such as demographics and individual vascular anatomy which may play a role in predicting periprocedural complications.

    Methods: A retrospective analysis of patients undergoing ASI for acute large vessel occlusion during a 2-year period was conducted. Demographic and individual vascular variations were correlated with revascularization (TICI 2b or 3) and a scoring system was devised to help predict problems with access and revascularization.

    Results: A total of 33 patients were included. Mean age was 70 years (range 26-95 years). Twelve patients presented with ICA occlusion, 18 with M1, and 3 with M2 occlusion, respectively. Scores on the scale ranged from 0-3. One point was given to arch type III, bovine arch in left-sided interventions, and acute CCA bends (>90). Scores of 0 were associated with 100% successful access and revascularization, scores of 1 had 66% successful access and revascularization, and scores 2 had 57% successful access and 42% successful revascularization. Higher scores (2 or more) had a statistically significant increased failure rate (p=0.03 for access, p=0.01 for revascularization). Patients older than 80 were more likely to pose access challenges (scores 2) and failed revascularization compared to younger patients (41% versus 14%, p=0.06).

    Conclusions: Vascular anatomy and age play an important role in the likelihood of successful lesion access and revascularization after large vessel occlusion. We propose a scoring system that can help clinicians identify potential poor candidates for conventional ASI and may require novel access strategies.

    Patient Care: Our study provides data on the likelihood of unsuccessful stroke intervention using stent-retrievers and discusses potential strategies that might provide a framework for operators alike.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify potential anatomical and demographic characteristics associated with a higher likelihood of unsuccessful stroke intervention using stent-retrievers, 2) Discuss potential strategies to overcome problems with stroke intervention, 3) Identify potential patients that may require unconventional access for stroke intervention


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