Introduction: Mechanical thrombectomy (MT) has been a powerful addition to the armamentarium for the treatment of ischemic stroke, significantly altering patient outcomes. Given its recent adoption, there is however a paucity of literature on functional outcomes and prognosis after MT.

Methods: We conducted a retrospective study on the182 patients who underwent MT for anterior circulation infarct at TJU from 2012-2017. We collected data on comorbidities, NIHSS, tPA, TICI, DWI characteristics, and functional outcomes at discharge. We performed logistic regression analysis to identify the significant predictors of clinical outcome, developed a grading scale, and performed a ROC curve analysis.

Results: In 182 patients, the median age was 65±15.8 years old and the NIHSS on arrival was 15.9±5.9 with 54.4% of them receiving tPA prior to MT. Recanalization was successful (TICI 2B-3) in 88.5% of patients and unsuccessful (TICI 0-2A) in 11.5%. Hemorrhagic conversion occurred in 58.2% of patients. On DWI, 92.9% of patients had a cortical infarct, 91.2% had subcortical and 84.8% had both. The motor cortex, Broca’s and Wernicke’s areas were affected in 56.0%, 22.5% and 18.7% respectively. The median surface area (SA) of cortical and subcortical infarct was 6.14cm2±11.5 and 4.53cm2±3.70 respectively. Logistic regression analysis showed age(p<0.001), worse NIHSS(p=0.008), lack of tPA (p=0.044), and cortical (p<0.001) and subcortical infarct SA(p<0.001) to be predictors of unfavorable outcome (mRS4-6) at discharge. The ROC curve demonstrated an AUC of 0.827 (p<0.001).

Conclusions: We propose a classification that predicts functional outcomes at discharge. It includes age(1 point for=70), NIHSS(1 point for=18), tPA(1 point for no tPA), cortical(1 point for=10cm2) and subcortical infarct SA(1 point for=6cm2). We provide the risk of unfavorable outcome based on total points and test our grading scale on a separate patient database.

Patient Care: Our study is the first step to establishing a classification system that will help guide the treating physician when discussing the goals of care with the family. Understanding the prognosis after mechanical thrombectomy in patients with anterior circulation strokes will allow for establishing the appropriate expectations and making informed decisions.

Learning Objectives: By the conclusion of this session, participants should be able to: 1.Appreciate the prognosis associated with reperfusion after mechanical thrombectomy for anterior circulation infarcts. 2.Utilize the location and size of the infarct to guide the decision-makers in an evidence-based manner.

References: 1. Saver JL, Goyal M, van der Lugt A, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: A meta-analysis. JAMA. 2016;316(12):1279-89. 2. Man S, Aoki J, Hussain MS, Wisco D, Tateishi Y, Toth G, et al. Predictors of Infarct Growth after Endovascular Therapy for Acute Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases.24(2):401-7. 3. Raoult H, Eugène F, Ferré J-C, Gentric J-C, Ronzière T, Stamm A, et al. Prognostic factors for outcomes after mechanical thrombectomy with solitaire stent. Journal of Neuroradiology. 2013;40(4):252-9.