Abstract WP2: Long-Term Functional Outcomes Following Mechanical Thrombectomy Stratified by Race- Insights From the STAR Collaboration

Introduction: Previous research reported higher prevalence of vascular risk factors and worse outcomes after stroke in non-white patients compared to whites. Whether similar results still apply in the post mechanical thrombectomy era remains unknown.

Methods: The STAR registry combined the prospectively maintained databases of 11 thrombectomy-capable stroke centers in the US, Europe, and Asia. Consecutive patients who underwent MT were included in these analyses. Baseline features, risk factors, location of occlusion, time from symptom onset, tPA receipt, procedural complication rates, symptomatic hemorrhage, and long-term functional outcome were compared between white and non-white patients. Multivariate logistic regression analysis was performed to evaluate the impact of race on long-term outcome.

Results: Total of 2,284 patients were included in this analysis. Of those, 1,436 (62.9%) were white. Baseline features and outcomes are summarized in table 1. Non-white patients were older ( 71 Vs 66, p=<0.001), more likely to be female ( 53.1% Vs 48.5%, p=0.034), had lower NIHSS on admission ( 15 Vs 16, p=<0.001), higher prevalence of hypertension, hyperlipidemia, diabetes, lower incidence of atrial fibrillation, higher rate of tPA receipt, shorter onset to groin access times, and longer procedural times. White patients had higher rates of successful revascularization (77.4% Vs 72.3%, p=0.006) and longer hospital stay. On multivariate logistic regression analysis, white race was an independent predictor of good 90-day outcome (OR 1.35, 95% CI 1.03-1.76, P=0.031) after controlling for age, sex, location of occlusion, IV-tPA, ASPECT score, procedure duration and final TICI score.

Conclusion: In this study, white race was independent predictor of good 90-day outcome. This finding could be due to higher prevalence of vascular risk factors in non-white patients.

Inadvertent Stent Retriever Detachment: A Multicenter Case Series and Review of Device Experience FDA Reports

Mechanical thrombectomy using retrievable stents or stent retriever devices has become the mainstay of intra-arterial therapy for acute ischemic stroke. The recent publication of a series of positive trials supporting intra-arterial therapy as standard of care for the treatment of large vessel occlusion will likely further increase stent retriever use. Rarely, premature stent detachment during thrombectomy may be encountered. In our multicenter case series, we found a rate of detachment of less than 1% (n = 7/1,067), and all were first-generation Solitaire FR devices. A review of the US Food and Drug Administration database of device experience yielded 90 individual adverse reports of detachment. There were 82, 1 and 7 detachments of Solitaire FR (first generation), Solitaire FR2 (second generation) and Trevo devices, respectively. We conclude with a brief overview of the technical and procedural considerations which may be helpful in avoiding this rare complication.