Intraarterial Treatment for Acute Ischemic Stroke: Analysis of Outcomes of Dissection Vs. Non-Dissection Mechanism in 445 Patients (P4.380)

Objective: To examine the safety and efficacy of intraarterial treatment (IAT) for acute ischemic stroke (AIS) due to cervical artery dissection (CAD) compared to non-CAD mechanism. Background: The safety and efficacy of IAT for AIS due to CAD (carotid and vertebral) has not been studied in a controlled trial. Methods: We studied consecutive admissions with AIS who received IAT between 1/2010 - 4/2015 and compared outcomes for patients with AIS who presented with CAD mechanism vs. other causes. Outcomes included functional independence (Modified Rankin Score ≤ 2 within 90-days), symptomatic intracerebral hemorrhage (sICH), in-hospital mortality, and procedural complications. Outcomes were univariately analyzed with Chi-square tests. Co-primary outcomes of functional independence and sICH were analyzed with multivariate logistic regression. Results: Of 3,671 patients with AIS, 445 patients received IAT and comprise our study population: 24 with CAD (5[percnt]: 18 carotid, 6 vertebral) and 421 with another cause. Unadjusted outcomes were similar by AIS cause of CAD vs. other: functional independence, 63[percnt] v. 54[percnt], p=0.42; sICH: 4[percnt] v. 6[percnt], p>0.99; mortality, 17[percnt] v. 16[percnt], p>0.99; procedural complications, 13[percnt] v. 4[percnt], p=0.09. Patients with CAD were younger (median age: 52 vs. 70, p < 0.001) with less severe stroke (median NIHSS: 13 vs. 18, p=0.03) than those with another cause of AIS. After adjustment for NIHSS and age, the odds of achieving functional independence (OR: 0.58 [0.19-1.78], p=0.34) and sICH (OR: 0.57 [0.07-4.66], p=0.60) were not significantly different in patients with CAD vs. other mechanism. Conclusions: Intraarterial treatment appears to be as safe and effective when used in patients with ischemic stroke due to CAD as in AIS patients with other causes. Following the major advances in IAT for AIS in the general population, IAT should be considered in patients with AIS due to a CAD. Disclosure: Dr. Jensen has nothing to disclose. Dr. Salottolo has nothing to disclose. Dr. McCarthy has nothing to disclose. Dr. Loy has nothing to disclose. Dr. Frei has received personal compensation for activities with Microvention, Covidien, Stryker, Siemens, and Penumbra as a consultant. Dr. Wagner has received personal compensation for activities with Genentech, Inc., as a speakers bureau member. Dr. Whaley has received personal compensation for activities with Clinical Data Management/Neurobase and Genentech. Dr. Bar-Or has nothing to disclose.