Abstract 80: Older Patients Benefit More From Complete Recanalization Following Thrombectomy

• Published in: Stroke (1970) 2018-01, Vol.49 (Suppl_1)
• Main Authors: Jayaraman, Mahesh V, Kiskhovich, Thomas, Hemendinger, Morgan, Baird, Grayson L, Tung, Eric L, Yaghi, Shadi, Cutting, Shawna, Haas, Richard A, McTaggart, Ryan A
• Format: Article
• Language: English
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.49.suppl_1.80

Abstract only Introduction: Higher rates of recanalization following thrombectomy are associated with better clinical outcomes. Specifically, patients with TICI 2c or 3 recanalization have higher degrees of functional independence as compared with TICI 2b recanalization. Older age is also associated with worse outcomes. We sought to determine if the magnitude of difference in outcomes between TICI 2c/3 and 2b is affected by age. Methods: We identified 157 consecutive patients with anterior circulation LVO over 24 months at a single center. Angiograms were reviewed blinded to clinical outcome. In 24 patients, TICI 2b or greater recanalization could not be achieved. This left 133 patients for analysis, with TICI 2c/3 recanalization in 72, and TICI 2b in 61. Primary outcome measures were independence (defined as mRs 0-2 at 90 days), and Utility weighted Rankin at 90 days. We analyzed the relationship between age and outcomes, comparing the TICI 2c/3 vs. 2b groups. Results: Patient age ranged from 19 to 92, median 73 (IQR 61-82). Median NIHSS was 17 (IQR 13-20). Median [IQR] time from imaging to reperfusion was 106 [80-141.5] minutes in the TICI 2c/3 group and 124 [86-150] minutes in the TICI 2b group, and did not increase with age. When comparing the relationship between age and outcomes, there was a greater decrease in functional outcome in those with TICI 2b versus TICI 2c/3 reperfusion. In patients younger than 70, 19/29 (66%) with TICI 2b achieved independence at 90 days, as compared with 19/26 (73%) in the TICI 2c/3 group. In patients 70 and older, 9/32 (28%) with TICI 2b achieved independence at 90 days, as compared with 26/46 (57%) in the TICI 2c/3 group, a significant difference (p=.02). The relationship between age and utility weighted Rankin at 90 days is highly significant (p=.0067) and summarized in the figure. Conclusions: The additional benefit of TICI 2c/3 over TICI 2b increases significantly with age. Higher levels of recanalization may benefit older patients to a greater extent.