E-084 Variability in endovascular treatment of intracranial internal carotid artery versus middle cerebral artery occlusions

Purpose Endovascular treatment (ET) for the acute management of ischemic stroke due to large vessel occlusions is the standard of care for anterior circulation. Meta-analysis has suggested equivalent recanalization and better clinical outcomes after ET for ICA and proximal MCA occlusion (1–2). The aim of our study was to compare these two cohorts and identify any variability/bias in presentations, imaging selection, technical and clinical efficacy. Materials and Methods This is a retrospective study of patients that underwent ET for ICA/MCA occlusions over a four-year period at three comprehensive stroke centers. We studied patient demographics, vascular risk factors, NIHSS, time of presentation, imaging, procedures details, and clinical outcomes. Chi-square, Mann-Whitney U and student t-tests were used for variables univariate analysis as appropriate. Multivariate analysis was performed to assess the comparability of the groups based on demographics and risk factors. Results 185 patients were studied (mean age, 68 ± 17; 55% women; median NIHSS, 16 ± 6). Both study cohorts were comparable regarding their age (65 ± 20 vs 69 ± 17, p=0.26) and past medical history of Hypertension, Diabetes Mellitus, Hyperlipidemia and Smoking habit (p=0.64, p=0.68, p=0.55, p=0.47 respectively). There was no statistically significant difference between both cohorts regarding their NIHSS (17 ± 6 vs 16 ± 6, p=0.23) or the time from onset to groin puncture (mean 5:43:48 vs 5:24:58, p=0.54). Moreover, there was no significant difference between mean ASPECT (8.3 ± 1.3 vs 8.6 ± 1.3, p=0.19) and mean CTP-rCBF Conclusions Significant procedural difficulty is encountered during ET of ICA relative to MCA occlusions, requiring increased procedural time and passes. Although final successful recanalization rates are equivalent, we noted a paradoxical trend for less functional independence with MCA occlusions this could be due to the higher rate of complications in the MCA cohort, and the better collaterals through the circle of Willis in the ICA cohort. Disclosures M. Aly: None. R. Abdalla: None. M. Hurley: None. A. Shaibani: None. S. Ansari: None.