Impact of Acute Interventions for Ischemic Strokes on Infarcted Tissue Volume: Comparison of MRI Profiles

Objective: To determine whether mechanical thrombectomy (MTB) alone or MTB with rTPA (combined therapy) for anterior circulation LVO stroke has significant impact in minimizing progression of infarct volume. Background: MTB has been recently proven an effective rescue therapy for anterior circulation LVO stroke. However, much uncertainty exists regarding the efficacy of MTB alone vs. combined therapy. Design/Methods: A retrospective chart review was performed of patients with anterior circulation LVO stroke treated with MTB alone or combined therapy from 05/2011 to 06/2017. Infarcted volumes of pre and post therapy (within 5 days) on MRI were calculated using ABC/2. Patient characteristics (i.e. stroke risk factors and NIHSS) were also obtained. The relationship between infarcted volumes, both acute intervention modalities, and patient characteristics were analyzed using a 1-within factor and 1-between factor analysis of variance and linear regression respectively. Results: Of 158 patients reviewed, 29 were included; 16 in MTB alone and 13 in combined therapy. Pre-intervention mean infarct volumes for MTB alone and combined therapy were 19.56cc+20.41SD (or 95% CI=8.69, 30.44) and 16.62cc+20.43SD (95% CI=4.27, 28.96) respectively (p=0.3111) and post-intervention were 101.1+94.64SD (95% CI=50.63, 151.50) and 61.69+58.01SD (95% CI=26.64, 96.75) respectively (p=0.1330). Mean differences of infarct volumes pre u0026 post intervention for each modality are 81.5+94.81SD (p=0.0008) and 45.08+48.48SD (p=0.0091), respectively. Although comparison of mean differences in infarct volumes pre and post-intervention between modalities was not significant (p=0.7385), individuals with MTB alone appeared to have twice increase in infarct volume compared to combined therapy. Effects of patient characteristics on infarct volume were not significant. Conclusions: In our study, although we did not find significant difference in mean infarct volume post intervention between MTB and combined therapy, we did observe a trend of increase in infarct volume in patients treated with MTB alone. This result should be further evaluated in larger, prospective studies. Disclosure: Dr. Gezalian has nothing to disclose. Dr. Moretz has nothing to disclose. Dr. Izumigawa has nothing to disclose. Dr. Cheung has nothing to disclose. Dr. Cristiano has nothing to disclose. Dr. Nist has nothing to disclose. Dr. Tsao has nothing to disclose. Dr. Jacobson holds stock and/or stock options in Genelux. Dr. Truong has nothing to disclose.