Abstract TP58: Initial Non-Contrast Computed Tomography Predicts Atherosclerotic M1 Occlusions and Poor Functional Outcomes After Mechanical Thrombectomy

• Published in: Stroke (1970) 2020-02, Vol.51 (Suppl_1)
• Main Authors: Weber, Matthew, Ume, Kiddy L, Dandapat, Sudeepta, Zevallos, Cynthia, Levy, Abigail, Siddiqui, Fazeel M, Ortega-Gutierrez, Santiago
• Format: Article
• Language: English
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.51.suppl_1.TP58

Abstract only Introduction: Intracranial atherosclerosis related occlusions (ICAS-O), occurring in 5-15% of all middle cerebral artery (MCA) infarcts, carry a poor functional outcome and high mortality despite mechanical thrombectomy (MT). We aimed to identify early non-contrast computed tomography (NCCT) predictors for ICAS-O and unfavorable outcomes in patients with M1 occlusions. Methods: We conducted a retrospective analysis of 104 consecutive patients presenting with acute M1 occlusions undergoing MT. Based on our previous observational experience, NCCT patterns that had been associated with atherosclerosis included the absence of visible hyperdense MCA sign, the presence of anterior temporal/insular hypodensity and the presence M1/M2 caliber asymmetry (diminutive vessels). These were used as predictors and were scored (1 for each) to build a 0-3 CT atherosclerosis score (CTAS) which was correlated with findings on cerebral angiogram, reperfusion status (TICI), 3-month Modified Rankin Scale (mRS), mortality, and other clinical variables. Results: CTAS was 3 in 16, 2 in 15, 1 in 41, and 0 in 30 patients. Two patients were excluded for poor quality NCCT. Age (69.1 ± 16.1), presenting NIHSS (15.7 ± 5.1), and time to groin (347.2 ± 281.4 min) were similar across all CTAS scores. Mortality and 3-month mRS both showed significant correlation with increasing CTAS (p=0.0198 and p=0.0111, respectively). CTAS 3 patients did poorly, carrying a mortality of 62.5%, and having a mean 3-month mRS of 5.1. The probability of unfavorable reperfusion (TICI 0, 1, and 2A) also increased with CTAS (p=0.0207). There was a significant correlation between CTAS and the presence of ICAS-O (p