Futile Revascularization after Mechanical Thrombectomy for Acute Ischemic Stroke: Pooled Analysis of the Multi MERCI, TREVO and TREVO 2 Trials (S35.004)

Objective: To characterize the frequency and predictors of futile revascularization (FR) in patients treated by mechanical thrombectomy with Trevo Retriever and Merci Retriever. Background: Successful revascularization after endovascular treatment may fail to improve outcome in a subset of acute stroke patients. Methods: We retrospectively analyzed the pooled data of subjects from the Multi MERCI, TREVO and TREVO 2 trials. FR was defined as the occurrence of poor outcome (mRS 蠅3 at 90 days) despite successful revascularization measured by a TICI 2b or 3. We evaluated demographic, clinical, angiographic variables and hemorrhage as covariates of FR. Results: Among 402 subjects, 235 subjects achieved successful revascularization in the pooled trials. A total of 228 subjects were included in outcome analysis. FR was observed in 122 of 228 (53.5%) subjects. FR was numerically less frequent with Trevo Retriever than with Merci Retriever (48.6% [53/109] vs. 58.0% [69/119]). Subjects with FR were older, had higher baseline NIHSS (20 vs. 17), higher SBP (153 vs. 138 mmHg), higher glucose (156 vs. 118 mg/gL), and more often had a history of hypertension and diabetes. Subjects with FR tended to have longer time from symptom onset to first device pass (4.9 vs. 4.4 hours; p=0.096), time from symptoms onset to procedure end (5.8 vs. 5.3 hours; p=0.064), and were more often with intubation (75.3% vs. 61.3%; p=0.051), had higher rates of hemorrhagic transformation and symptomatic hemorrhage (13.9% vs. 0%). Independent predictors of FR were NIHSS and age. Among subjects with baseline NIHSS 8-20, 53.2% reported 90 days mRS≤2; while 30.9% among those with NIHSS 21-30. Subjects with FR had higher NIHSS at discharge (17.3 vs. 3.2) and longer lengths of hospitalization (10.1 vs. 7.7 days). Conclusions: Futile revascularization is relatively frequent in patients treated by mechanical thrombectomy, particularly among those were older or with severe neurological deficits. Further studies are needed to elucidate the predictors of FR in patients treated with Trevo Retriever and Merci Retriever, respectively. Disclosure: Dr. Shi has nothing to disclose. Dr. Liebeskind has received personal compensation for activities with Concentric Medical, Inc. and CoAxia, Inc. Dr. Xiang has received personal compensation for activities with Stryker as a consultant. Dr. Ge has received personal compensation for activities with Stryker. Dr. Feng has nothing to disclose. Dr. Albers has received personal compensation for activities with Genentech, Inc., and Lundbeck Research USA Inc. Dr. Albers has received research support from Genentech Inc., Aventis Pharmaceuticals Inc., Sanof-Aventis Pharmaceuticals, Inc., Biogen Idec, Ono Pharmaceutical, and AstraZeneca Pharmaceuticals. Dr. Budzik has received personal compensation for activities with Concentric Medical, Inc. Dr. Devlin has received personal compensation for activities with Concentric Medical, Inc. as a consultant. Dr. Gupta has received personal compensation for activities with Stryker Neurovascular, Rapid Medical, and Covidien. Dr. Gupta has received personal compensation in an editorial capacity with the Journal of Neuroimaging, and Interventional Neurology. Dr. Jansen has received personal compensation for activities with Stryker. Dr. Jovin has received personal compensation for activities with Covidein, Concentric Medical Inc., Stryker, and Silk Road Medical. Dr. Jovin has received personal compensation in an editorial capacity for Journal of Neuroimaging. Dr. Killer-Oberpfalzer has nothing to disclose. Dr. Lutsep has received personal compensation for activities with Concentric Medical, Stryker, Co-Axia and AGA Medical. Dr. Lutsep has received personal compensation in an editorial capacity for the eMedicine Neurology Journal, Dr. Macho has nothing to disclose. Dr. Nogueira has received personal compensation for activities with Concentric Medical, Inc., ev3 Neurovascular, Inc., Coaxia, Inc., and Rapid Medical, Inc. Dr. Rymer has received personal compensation for activities with Covidien Medical. Dr. Smith has received personal compensation for activities with Stryker Neurovascular, Covidien, and Jan Medical. Dr. Smith has received research support from Jan Medical. Dr. Wahlgren has nothing to disclose. Dr. Duckwiler has received personal compensation for activities with Concentric Medical, and Ev3 Medical.