Abstract P533: Incidence and Outcomes of Thrombectomy Rescue Therapies in Acute Basilar Artery Occlusions

• Published in: Stroke (1970) Vol. 52; no. Suppl_1; p. AP533
• Main Authors: Lun, Ronda, Walker, Greg B, Weisenburger-Lile, David, Lapergue, Bertrand, Guenego, Adrien, heran, navraj s, Siu, William, Dargazanli, Cyril, Benali, Amel, Gory, Benjamin, Richard, Sebastien, Ducroux, Celina, Piotin, Michel, BLANC, RAPHAEL, Labreuche, Julien, Lucas, Ludovic, Haddad, John, Aubertin, Mathilde, vannier, stephane, Guillen, Maud, Eugene, Francois, Maier, Benjamin, Marnat, Gaultier, Detraz, Lili, Bourcier, Romain, FAHED, Robert
• Format: Journal Article
• Language: English
• Published: Lippincott Williams & Wilkins 01.03.2021
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/str.52.suppl_1.P533

BackgroundHematoma expansion (HE) is an important therapeutic target in intracerebral hemorrhage. Recently proposed HE definitions have not been validated, and no previous definition has accounted for withdrawal of care (WOC). ObjectiveTo compare conventional and revised definitions of hematoma expansion (HE), while accounting for WOC. MethodsWe analyzed data from the ATACH-2 trial, comparing revised definitions of HE incorporating intraventricular hemorrhage (IVH) expansion to the conventional definition of “≥6 mL or ≥33%”. The primary outcome was modified Rankin Scale of 4-6 at 90-days. We calculated the incidence, sensitivity, specificity, positive and negative predictive values, and c-statistic for all definitions of HE. Definitions were compared using non-parametric methods. Secondary analyses were performed after removing patients who experienced WOC. ResultsPrimary analysis included 948 patients. Using the conventional definition, the sensitivity was 37.1% and specificity was 83.2% for the primary outcome. Sensitivity improved with all three revised definitions (53.3%, 48.7%, and 45.3%, respectively), with minimal change to specificity (78.4%, 80.5%, and 81.0%, respectively). The greatest improvement was seen with the definition “≥6 mL or ≥33% or any IVH”, with increased c-statistic from 60.2% to 65.9% (p < 0.001). Secondary analysis excluded 46 participants who experienced WOC. The revised definitions outperformed the conventional definition in this population as well, with the greatest improvement in c-statistic using “≥6 mL or ≥33% or any IVH” (58.1% vs 64.1%, p < 0.001). ConclusionsHE definitions incorporating intraventricular expansion outperformed conventional definitions for predicting poor outcome, even after accounting for care limitations.