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  • Mechanical Thrombectomy in the Post-MR RESCUE Era: Modern Technology Improves Outcomes. A Single Center Experience.

    Final Number:

    Jonathan Pace MD; Jeffrey Tait Nelson MD; Arunit Jessey S Chugh BS; Cathy Sila MD; Jeffrey Sunshine, MD; Robert Tarr MD; Nicholas C. Bambakidis MD; Yin C. Hu MD

    Study Design:

    Subject Category:
    Ischemic Stroke

    Meeting: AANS/CNS Cerebrovascular Section 2017 Annual Meeting

    Introduction: In the post-MR RESCUE trial era, the pursuit of interventions which improve patient outcome in ischemic stroke continue to be at the forefront of clinical inquiry, especially given the critiques of MR RESCUE and IMS III.

    Methods: A single-institution retrospective study was conducted to evaluate clinical outcome of patients who have undergone magnetic resonance imaging (MRI) prior to endovascular recanalization therapy since 2013 in the post-MR RESCUE era. From January 1, 2013 to July 1, 2016, 87 patients who were treated with endovascular thrombectomy were screened. 2 patients were excluded who had previous infarctions, 3 were excluded for being treated with angioplasty alone, and 19 were excluded if treated outside of the 8-hour post-infarction window. 63 patients were included for analysis.

    Results: 63 patients were analyzed. 54 had MCA thrombi, 6 had ICA terminus thrombi, and 3 had basilar artery thrombi. 28 underwent thrombectomy with stent-retriever devices, 15 were treated with aspiration, and 14 underwent combined stent-retriever/ aspiration treatment. 6 patients were treated with microwire agitation. 42 (67%) of the patients treated achieved a TICI score of 2b or 3 post intervention. The average pre-procedure NIHSS was 17. The average NIHSS at 72 hours was 8. The mean follow-up modified Rankin Score was 2.5, with 30 (48%) of patients achieving a modified Rankin Score 0-2. There were 2 (3%) symptomatic hemorrhages.

    Conclusions: In our single-institution experience, the utilization of MRI screening coupled with modern techniques in performing mechanical thrombectomy has allowed for significant immediate success objectively with a high percentage of patients achieving a TICI 2b or 3 score, and a long term success with 48% of patients with a modified Rankin Score of 0-2. This study supports endovascular reperfusion treatment in acute stroke using rapid-sequence MRI. New prospective studies are needed to reinforce this finding.

    Patient Care: This will improve patient care by demonstrating that MRI screening in ischemic stroke, coupled with modern thrombectomy techniques and technologies, can lead to improved patient outcomes and recanalization rates, with a large portion of the patients achieving a mRS of 0-2.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) identify criteria for aggressively pursuing mechanical thrombectomy in ischemic stroke patients; 2) recognize that new technology has helped to improve outcomes in ischemic stroke patients; 3)re-evaluate the importance and utility of using MRI to directly guide patient care with regards to stroke management


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