Patterns and Outcomes of Endovascular Therapy in Mild Stroke: A Florida-Puerto Rico Collaboration (P1.3-029)

Objective: To evaluate the current practice patterns, safety and outcomes of endovascular therapy (EVT) in patients who present with mild versus moderate/severe ischemic stroke. Background: Patients with mild stroke were largely excluded from the recent randomized trials of endovascular therapy (EVT), which proved the superiority of EVT over best medical management in patients with a large vessel occlusion. Design/Methods: From Jan 2010 to Jan 2018, 127,794 ischemic stroke patients were enrolled in the Florida-Puerto Rico Registry. Patients presenting within 24 hours of symptoms who received EVT were classified into mild (NIHSS ≤ 5) or moderate/severe (NIHSS >5) categories. Differences in clinical characteristics and outcomes were evaluated using multivariable logistic regression. Results: Among 3,786 EVT patients, median age 73 (IQR=20), 50% women, 446 (12%) had NIHSS≤5. Compared to NIHSS>5, mild patients arrived later to the hospital (median 138 vs. 101 min), were less likely to receive IV tPA (30% vs. 43%), had a longer door to puncture time (median 167 vs. 115 min) and had more distal occlusions (42%, vs. 19.3%). Younger age (OR=2.40, 95% CI 1.60–3.60), prior history of atrial fibrillation (OR=1.83, 95% CI 1.47–2.27), arrival by EMS (OR=2.09, 95% CI 1.45–3.02) and treatment in large hospital (OR=2.86, 95% CI 1.10, 7.39) were independently associated with NIHSS ≤5 . Amongst EVT patients with NIHSS≤5, 76% were discharged home/rehabilitation and 64% were able to ambulate independently at discharge as compared to 53% and 32% of patients with NIHSS>5. Symptomatic ICH occurred in 4% of mild stroke EVT patients and 6.4% in those with NIHSS>5. Conclusions: Despite lack of evidence-based recommendations, 12% of patients receiving EVT in clinical practice have mild neurological presentations. Factors such as age, mode of hospital arrival and hospital size were associated with mild stroke symptoms among EVT patients. Our data suggest safety an overall favorable outcomes in mild stroke receiving EVT. Disclosure: Dr. Asdaghi has nothing to disclose. Dr. Yavagal has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Medtronic, Cerenovus, Rapid Medical, Neuralanalytics, GLG, Guidepoint. Dr. Yavagal has received research support from Rapid Medical, Neuralanalytics. Dr. Wang has nothing to disclose. Dr. Mueller has nothing to disclose. Dr. Bhatt has nothing to disclose. Dr. Gardener has nothing to disclose. Dr. Gutierrez has nothing to disclose. Dr. Marulanda-Londono has nothing to disclose. Dr. Koch has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Cerepeutics and MiamiMedTech. Dr. Dong has nothing to disclose. Dr. Oluwole has nothing to disclose. Dr. Hanel has nothing to disclose. Dr. Mehta has nothing to disclose. Dr. Robichaux has nothing to disclose. Dr. Nobo has nothing to disclose. Dr. Zevallos has nothing to disclose. Dr. Rundek has received research support from Bristol-Myers Squibb, NINDS. Dr. Sacco has received research support from NIH/NINDS, Boeringher Ingelheim and Bristol-Myers Sqibb. Dr. Romano has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Genentech, Vycor/NovaVision. Dr. Romano has received research support from NIH/NIMH; NIH/NINDS; StrokeNet; Genentech .