Reasons and Outcomes of Patients Who Do Not Receive Mechanical Thrombectomy for Acute Ischemic Stroke (P4.219)

Objective: Understand why patients presenting within the window for endovascular therapy did not receive it and their outcomes. Background: Many examine patient outcomes following endovascular therapy for acute ischemic stroke, but little is known about the reasons and outcomes of patients who didn’t get it. Design/Methods: We retrospectively examined a cohort of 275 patients with a discharge diagnosis of ischemic stroke, NIHSS≥6 and last known normal (LKN) time Results: Reasons patients did not receive therapy were patent major intracranial vessels (32%), no penumbra on CT or MRI (11.7%), large core infarct (16%), low NIHSS or significant improvement (8%), cerebral ischemia not suspected at admission (6.6%), poor baseline (6.2%) and advanced age (4.4%). Mean decision time for patients without penumbra or large core infarcts was not different from other patients in the cohort. Inability to treat patients within 6 hours was associated with a longer decision time (119 minutes longer, CI 54–185, p value =0.0004), but the time increase was due to transfer time, not decision time relative to arrival at the tertiary care center. Patients for whom cerebral ischemia was not considered at admission were most likely to present with seizure (33%) or posterior circulation symptoms (22%). Conclusions: In our cohort the most common reasons patients did not receive intervention were patent major intracranial vessels, no penumbra and large core infarction. These patients would be unlikely to benefit and might be harmed by endovascular intervention, therefore they were appropriately not treated. Disclosure: Dr. Wang has nothing to disclose. Dr. Rizvi has nothing to disclose. Dr. Dickey has nothing to disclose. Dr. Ramos Estebanez has nothing to disclose. Dr. Xiong has nothing to disclose. Dr. De Georgia has nothing to disclose. Dr. Sila has nothing to disclose. Dr. Furlan has nothing to disclose. Dr. Sundararajan has nothing to disclose.