ABSTRACT
Introduction: Red blood cell (RBC) rich vs fibrin rich clots have different mechanical properties and greater knowledge about clot composition in the context of clinical, imaging, and procedural factors in mechanical thrombectomy (MT) may help with procedural optimization. The EXCELLENT Registry (NCT03685578) is a prospective, global, multi-center, observational registry of EmboTrap as the first line MT device for large vessel occlusion (LVO). We present an interim analysis of clot collected per pass in the registry. Methods: Five hundred thirty-three clot specimens from 376 subjects were collected by 20 sites and sent for analysis by independent Central Labs under standardized protocol. Analysis was interrupted by COVID-19, but the labs were fully operational as of June 2020 and on track to deliver results for 300 subjects in Q4. At the time of abstract submission, composition data for 234 clots from 163 subjects was available. All available data will be presented at the time of the conference. Results: Cardioembolic etiology (n=100) was associated with lower RBC (40.2 vs 47.2%) and higher fibrin content (31.7 vs 26.7%) compared to large artery disease (n=12). Hyperdense/vessel susceptibility sign (78+, 24-, per independent imaging core lab) corresponded to higher mean RBC content (44.4 vs 34.9%). Treatment with IV tPA (60+, 91-) had no clear impact on clot composition (42.3 vs 40.6% RBC;30.4 vs 30.0% fibrin). Notably, clots retrieved with the first 2 passes of were more RBC rich (42.1 vs 28.0%) and clots retrieved in higher passes had a higher average fibrin content (35.5 vs 29.6%) suggesting that higher fibrin content leads to greater refractoriness. Conclusions: Clot density/susceptibility on baseline imaging, stroke etiology and number ofthrombectomy passes were associated with differential clot composition. These findings may havepotential implications for the development of better MT strategies.
ABSTRACT
Background and Purpose: Randomized controlled trials have demonstrated the importance of time to endovascular therapy (EVT) on clinical outcomes in large vessel occlusion (LVO) acute ischemic stroke. Delays to treatment are particularly prevalent when patients require a transfer from hospitals without EVT capability onsite. A novel computer aided triage system, Viz LVO, has the potential to streamline workflows. This platform includes an image viewer, communication system, and an artificial intelligence (AI) algorithm that automatically identifies suspected LVO strokes on CTA imaging and rapidly triggers alerts. We hypothesize that the Viz application will decrease timeto- treatment. Methods: A prospective database was assessed for patients who presented to a stroke center utilizing Viz LVO in the Mount Sinai Health System in New York and underwent EVT following transfer for LVO stroke between July 2018 and March 2020. This time period was chosen due to the COVID-19 pandemic affecting stroke workflow after March 2020. Time intervals were compared for 55 patients divided into Pre- and Post-Viz cohorts. Results: The median initial door-to-neuroendovascular team (NT) notification time interval was significantly faster (25.0 minutes [IQR=12.0] vs 40.0 minutes [IQR=61.0];p=0.01) with significantly less variation (p<0.05). The median initial door-to-skin puncture time interval was 25 minutes shorter in the Post-Viz cohort, although not statistically significant (p=0.15). Post Viz LVO implementation, the Viz notification was the first NT notification 38% (10/26) of the time. Conclusions: Our preliminary results have shown that Viz LVO implementation is associated with earlier, more consistent NT notification times and potentially treatment times. This platform presents a novel application of AI that can serve as an early warning system and a failsafe to ensure that no LVO is left behind. Further studies are warranted.(Figure Presented).