Abstract 407: Key Predictors Of 90‐Day Functional Outcome For Patients With Large Infarct Core Undergoing Endovascular Therapy In Real‐World Practice

Background Recent randomized trials have shown a benefit for patients with large infarct core undergoing endovascular therapy (EVT), however the key factors to predict long‐term functional outcome remain unclear. Here in this real‐world registry‐based cohort study, we evaluated the clinical and imaging variables that have the largest impact on 90‐day mRS outcome for patients undergoing large core EVT. Methods Consecutive patients undergoing EVT were identified with pre‐treatment ASPECTS 0 to 5 at four comprehensive stroke centers in Houston, TX. Baseline clinical and imaging characteristics were compared. The cohort was divided a priori into 80:20 training and testing sets for the final analysis. Multivariable logistic regression was used to evaluate the association between variables of interest and the primary outcome, defined as 90‐day mRS 0‐3. The final model performance was measured by area under the receiver operating characteristic curve (AUROC). Secondarily, we evaluated predictors of symptomatic hemorrhage by ECASS‐II definition. Results Among 114 patients with large core infarcts, the median age was 65, 50% were female, median NIHSS was 19 IQR 16,22, and median ASPECTS was 5 IQR 4,5. A total of 35.1% received IV thrombolysis, and 8.8% experienced symptomatic hemorrhagic transformation (see Table 1). Patients who had poor 90‐day mRS outcomes tended to be older, had a higher baseline NIHSS, lower ASPECTS, and required more EVT passes. In univariable logistic regression, 3 or more EVT passes was associated with poor 90‐day outcome (OR 2.80 95% CI 1.10‐8.19, p = 0.041); however, this association became nonsignificant after adjusting for covariables including age, NIHSS, and TICI score. In the multivariable analysis, only age and NIHSS remained significantly associated with poor 90‐day mRS (see Table 2). Age ≥75 led to about 5 times greater likelihood of poor outcome, and each 5‐point increase of NIHSS increased the likelihood by approximately 10%. No significant variables predicting symptomatic intracranial hemorrhage were identified. The ROC curve analysis revealed an AUROC of 0.771 for the final model predicting 90‐day mRS (see Figure 1). Conclusion In this real‐world registry cohort of patients with large‐core ischemic strokes treated with EVT, older age and high baseline NIHSS were significantly associated with a poor 90‐day mRS outcome. A distinct difference in likelihood of poor outcome was seen at age 75, with ≥75 leading to 5 times greater likelihood. While lower ASPECTS and increased EVT passes were associated with a poor outcome in univariable analysis, these factors were not independently predictive after adjustment. image