Abstract Details

Title DAWN versus modified Clinical-ASPECTS Mismatch Selection for Stroke Endovascular Therapy in Late Presenting Strokes

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S57 - Acute Treatment and Imaging of Ischemic Stroke (1:00 PM-1:11 PM)

Poster/Presentation
Number 001

Background The benefit of thrombectomy in large vessel acute ischemic stroke (LVOS) beyond the 6-hour time window in now well established. However, the Optimal patient selection paradigm remain to be established.

Objective

To evaluate the performance of two imaging selection paradigms in a cohort of endovascularly-treated LVOS.

Design/Methods Review of a prospectively collected database of endovascular patients with anterior circulation LVOS, adequate CTP maps, NIHSS ≥10 and presenting beyond the 6-hour window from 01/2014 to 06/ 2018 in a clinical setting where no specific ASPECTS or CTP criteria defined treatment selection. Patients were assessed for thrombectomy eligibility by each 2 mismatch criteria: DAWN Clinical-Core Mismatch (DAWN-CCM): between age-adjusted NIHSS and CTP-derived ischemic core volume and modified Clinical-ASPECTS Mismatch (mCAM) defined as ASPECTS 6-10 and one of the following criteria: NIHSS ≥ 10 and 0-1 Cortical-ASPECTS (M1-6 area) Involvement (any age);NIHSS ≥ 10 and 0-2 Cortical-ASPECTS (M1-6 areas) Involvement (and age < 80 years old);NIHSS ≥ 20 and 0-3 Cortical-ASPECTS (M1-6 areas) Involvement (and age < 80 years old). Clinical outcomes were compared.

Results 259 patients met inclusion criteria. mCAM had a higher inclusion rate as compared to the DAWN-CCM criteria (88.8%vs85.3%). The proportions of selected patients were statistically different between groups (p=0.001). Both mCAM(+) and DAWN-CCM(+) patients had higher rates of 90-day good outcomes (modified Rankin scale 0-2) compared to non-selected counterparts (45.7%vs13.6%,p=0.004 and 45.9%vs18.5%,p=0.007 respectively). mCAM(+) had lower rates of 90-day mortality than mCAM(-) patients (21.3%vs40.9%,p=0.04). However there was a non-statistically significant trend towards lower mortality rates in DAWN-CCM (+) patients (21.1%vs38.5%,p=0.0.05). The abilities of mCAM and CCM to predict good outcomes were similar as assessed by the c-statistic, Akaike and Bayesian information criterion.

Conclusions mCAM and DAWN-CCM selection paradigms have similar inclusion rates and outcome discrimination ability. mCAM could represent a good substitute in centers where access to advanced imaging is more limited.

Authors/Disclosures
Mehdi Bouslama, MD (University at Buffalo Neurosurgery) PRESENTER	Dr. Bouslama has nothing to disclose.
Diogo C. Haussen, MD	Dr. Haussen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Stryker. Dr. Haussen has received stock or an ownership interest from Viz AI.
	No disclosure on file
	No disclosure on file
	No disclosure on file
Michael R. Frankel, MD (Emory Univ School of Med/Dept of Neuro)	The institution of Dr. Frankel has received research support from Nico Corporation, Inc.
Raul G. Nogueira, MD (UPMC Stroke Institute)	Dr. Nogueira has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron (consulting fees) as well as for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze ( stock options). Dr. Nogueira has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law Firms. Dr. Nogueira has received stock or an ownership interest from Viz-AI, Perfuze, Cerebrotech, Reist/Q'Apel Medical, Truvic, and Viseon. The institution of Dr. Nogueira has received research support from Cerenovus.

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