Abstract WP43: Body Mass Index and Clinical Outcomes in Large Vessel Occlusion Acute Ischemic Stroke After Endovascular Therapy: The Obesity Paradox

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Background: Obesity has been associated with increased morbidity and mortality in the general population. However, several reports have described lower mortality rates in overweight or obese patients as compared to normal weight ones. Several studies have investigated the phenomenon, commonly known as the obesity paradox, with mixed results thus far. We sought to determine whether clinical outcomes differ between patients with acute ischemic stroke after endovascular therapy according to their body mass index (BMI). Methods: We reviewed our prospectively collected endovascular database at a tertiary care academic institution. All patients that underwent endovascular therapy for acute large vessel occlusion acute ischemic stroke were categorized according to their BMI into four groups (1) underweight (BMI<18.5), (2) normal weight (BMI=18.5-25), (3) overweight (BMI=25-30) and (4) obese (BMI>30). Baseline characteristics, procedural radiological as well as outcome parameters were compared. Results: A total of 926 patients qualified for the study of which 20 (2.2%) were underweight, 253 (27.3%) had a normal weight, 315 (34%) were overweight and 338 (36.5%) obese. When compared with normal weight (reference) overweight patients had higher rates of dyslipidemia as well as diabetes and higher glucose and HbA1c levels while obese patients were younger, less often smokers and had higher rates of hypertension as well as diabetes and higher glucose and HbA1c levels. Other baselines characteristics including NIHSS and ASPECT scores as procedural characteristics were comparable between groups. In terms of outcomes, rates of successful reperfusion (mTICI 2b-3), parenchymal hematomas, 90-Day good clinical outcomes (modified Rankin scale, mRS 0-2) and 90-day mortality were comparable between BMI groups. On multivariate analysis, BMI was not associated with good outcomes nor mortality whether as a continuous variables or a categorical variable comparing groups with normal weight patients (reference) two by two. Conclusions: In stroke patients treated with mechanical thrombectomy, BMI does not seem to be associated with outcomes. However, patients who are overweight or obese have more co-morbities and should strive for a normal weight.

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