P-027 Ultra-early functional improvement after stroke thrombectomy – predictors and implications

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Introduction Neurocritical care is routinely offered to patients post neurothrombectomy of anterior large vessel occlusion (LVO) strokes. We aim to study the relationship between immediate improvement in NIHSS score on outcomes post thrombectomy and potential implications for requiring neurocritical care. Methods We performed a retrospective review of anterior LVO (internal carotid/proximal middle cerebral artery) patients undergoing neurothrombectomy between January 2015-December 2018. Demographic, clinical (NIHSS score on admission and within 30 minutes post recanalization, time last know well-TLKW), and imaging (ASPECTS, TICI, intracranial hemorrhage) information was analyzed. Ultra-early functional improvement (Ultra-EFI) was defined as NIHSS score <6 within 30 minutes of successful recanalization. We analyzed the incidence and predictors of ultra-EFI and explored reasons for neurological decline post ultra-EFI. Results Of the 343 anterior LVO patients undergoing neurothrombectomy, mean age was 71 ±15 and 46% were males. Mean NIHSS was 17±6 and TLKW to arrival was 9±11 hours. Ultra-EFI was observed in 23% (79/343) of patients. Independent predictors of ultra-EFI include lower pre-treatment NIHSS (), favorable ASPECTS (), and lower systolic blood pressure (). Rates of 90-day-mRS 0-2 were higher (71% VS 33%, P<0.01) and the rate of mortality (8% VS 28%, P<0.01) was lower in the ultra-EFI group compared to the non-ultra-EFI group. Amongst patients with ultra-EFI, 1.3% (1/79) experienced increase in NIHSS by ≥4 points. This patient received thrombolysis, achieved TICI-2B recanalization, and follow-up neuroimaging revealed a parenchymal hemorrhage and an infarct volume of 44 ml. None of the patients required continuous antihypertensive infusions. Conclusion Approximately 23% of anterior LVO stroke patients undergoing neurothrombectomy have a NIHSS score of <6 within 30 minutes of successful recanalization. Approximately 1% of them experience significant decline in neurological status within 24 hours of the procedure with the majority achieving functional independence at 90 days. Need for advance neurocritical care should be re-evaluated in these patients. Disclosures S. Desai: None. D. Tonetti: None. G. Nayar: None. A. Morrison: None. K. Shah: None. T. Jovin: None. A. Jadhav: None.

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