E-086 Factors associated with prolong puncture to reperfusion times in radial and femoral access for anterior circulation large vessel occlusions undergoing mechanical thrombectomy. (23rd July 2022)

• Record Type: Journal Article
• Authors: Catapano, J; Koester, S; Naik, A; Rangel, I; Stonnington, H; Winkler, E; Srinivasan, V; Desai, S; Ducruet, A; Albuquerque, F; Jadhav, A
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A123
• Page End: A123
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.197
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Introduction: Mechanical thrombectomy for acute ischemic large vessel occlusion has varying degrees of catheterization and access difficulties based on anatomical and intravascular differences. The aim of this study was the assess the factors involved in prolonged puncture to reperfusion times in radial and femoral access in anterior circulation large vessel occlusions. Methods: We retrospectively compared transradial and transfemoral access for acute ischemic stroke at two high-volume comprehensive stroke centers from 1/1/2020–6/30/2021. Patient characteristics, demographics, B.A.D scores, and procedure details were collected. Patients requiring crossover between access sites were excluded, and femoral and radial access was analyzed separately. The 75 th percentile was used to determine which patients had prolonged puncture to reperfusion time (PTR). Univariate analysis was used to determine factors associated with these cutoffs. A good clinical outcome was defined by NIHSS < 8 on discharge and at 24 hours post-thrombectomy. Univariate analysis used Wilcoxon rank-sum test for continuous outcomes, while chi-square test and Fisher's exact test were used for categorical comparisons. Significance was defined as p < 0.05. Results: A total of 235 patients were analyzed, 178 (75.7%) of which had transfemoral access. In the transfemoral cohort, the mean PTR time was 31.95 min (sD 24.06 min, 75 th percentile = 33), while the transradial cohort had a mean PTR of 33.81 min (sD 30.58, 75 th percentile = 40 min). Prolonged PTR was not associated with significantly different clinical outcomes in either cohort In the transfemoral cohort, a B.A.D. score of >/= 2 was more common in prolonged PTR time than a non-prolonged PTR (18 (40%) vs 25 (21%), p = 0.027, respectively), which was not observed in the transradial cohort (Table 3). Univariate predictors of transfemoral prolonged PTR included B.A.D. scores >/= 2 (OR = 2.45 [1.16, 5.17], p = 0.018), tandem occlusion (OR = 4.44 [1.85, 10.9], p < 0.001), and > 2 passes (OR = 10.2 [4.42, 25.1], p < 0.001) (Table 2). In the transradial cohort, only > 2 passes was a univariate predictor of prolonged PTR (OR = 3.68 [1.10, 14.8], p = 0.045) (Table 4). Conclusion: In patients undergoing femoral access for mechanical thrombectomy of anterior circulation occlusions, a prolong puncture to reperfusion time is associated with higher B.A.D scores, tandem occlusion, and > 2 passes. While radial access only >2 passes was associated with a prolonged puncture to reperfusion time. Future research should evaluate these effects in larger patient populations with more robust consideration of anatomical and intravascular variation. Disclosures: J. Catapano: None. S. Koester: None. A. Naik: None. I. Rangel: None. H. Stonnington: None. E. Winkler: None. V. Srinivasan: None. S. Desai: None. A. Ducruet: None. F. Albuquerque: None. A. Jadhav: None.