Description
- Abstract:
- The current standard of care for emergent large vessel occlusions is mechanical thrombectomy, in conjunction with IV tissue plasminogen activator (tPA). This treatment has been shown to have dramatic clinical benefit, both reducing mortality and improving functional independence. Even with the dramatic improvement in treatment outcomes, numerous unstudied factors still remain to be investigated. We reviewed 310 thrombectomy patients at Rhode Island Hospital between January 2015 and May 2017 in order to see how several factors affect outcomes, including optimal reperfusion targets based on demographics such as age and gender, and the effect that tPA has on reperfusion rates. Regarding patient age, we found that the benefit of TICI 2c/3 recanalization increases with age. Patients over 70 had a higher rates of functional independence when comparing TICI 2b vs. TICI2c/3 reperfusion (χ2, p=.013), versus patients under 70 (χ2, p=.54). Early recanalization rates following IV-tPA are low, especially when workflow is optimized to minimize time between tPA bolus and start of angiography, regardless of location at only 9.5%. With thrombectomy, tPA pre-treatment vs. non-tPA treated did not result in higher rates of recanalization (χ2, p=.54). In fact, it caused lower rates of TICI2c/3 and lower overall successful recanalizations. With the advent of better practices and faster interventions, our current standard of care to administer tPA to all eligible patients may in fact be lowering stroke treatment success.
- Notes:
- Scholarly concentration: Non-Scholarly concentrator
- All rights reserved
Citation
Kishkovich, Thomas, McTaggart, Ryan, Baird, Grayson, et al.,
"Assessing stroke outcomes post-thrombectomy: How functional independence changes with TICI score and age, and how tPA pre-treatment may lead to lower TICI reperfusion scores"
(2017).
Warren Alpert Medical School Academic Symposium.
Brown Digital Repository. Brown University Library.
https://repository.library.brown.edu/studio/item/bdr:698099/
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Warren Alpert Medical School Academic Symposium
The Warren Alpert Medical School Academic Symposium is an annual event at Warren Alpert Medical School of Brown University that provides Year II medical students a venue to present their summer research in a poster format. Participation in the Symposium …...