O-022 General Anesthesia, Baseline ASPECTS, Time to Treatment, and IV TPA Impact Intracranial Hemorrhage after Stentriever Thrombectomy: Pooled Analysis from SWIFT PRIME, SWIFT and STAR Trials

Introduction Despite the proven benefit of Solitaire for treatment of acute ischemic stroke, symptomatic intracranial hemorrhage (ICH) remains the most feared procedural complication. The aim of this analysis was to identify the factors determining ICH after neurothrombectomy with Solitaire stentriever. Methods All patients (N = 389) treated with Solitaire in SWIFT, SWIFT PRIME, and STAR trials were analyzed for incidence of 5 different ICH subtypes. Each ICH subtype was correlated with baseline clinical, imaging and procedural characteristic (age, NIHSS, hypertension, diabetes, atrial fibrillation, hyperglycemia, INR, platelet count, ASPECTS, general anesthesia, collateral grade, number of devices passes, final TICI, rescue therapy, IV TPA). Multivariate stepwise logistic regression model was used to identify the predictors of individual ICH subtypes. Results ICH was observed in 21.6% (N = 84) of which sICH was 1.0% (N = 4), hemorrhage in ischemic territory (HIT) 19.3% (N = 75), PH 5.4% (N = 21), and SAH 2.3% (N = 9). The most significant predictors of any ICH, HIT, and PH are included in Table 1. No specific predictors of SAH, and sICH were identified. Patients who achieved functional independence at 90 days (mRS 0–2) had significantly lower incidence of any ICH, HIT, PH, and no SICH (Table 2). Conclusions Higher baseline ASPECTS, better collaterals and general anesthesia are associated with lower incidence of ICH after neurothrombectomy with Solitaire stentriever. Prolonged time to treatment increases the risk of parenchymal hematoma and hemorrhage in ischemic territory. Parenchymal hematoma is distinctly associated with IV TPA. Of all ICH subtypes, sICH has the strongest impact on functional independence. Disclosures R. Raychev: None. J. Saver: 2; C; Medtronic, Stryker, Boehrniger, Neuravia. R. Jahan: 1; C; Medtronic. 2; C; Medtronic. R. Nogueira: 2; C; Medtronic, Stryker. M. Goyal: 2; C; Medtronic. V. Pereira: 2; C; Medtronic, Stryker. J. Gralla: 2; C; Medtronic. E. Levy: 2; C; Pulsar, Blockade Medical LLC Medina Medical Inc,. 4; C; Intratech Medical, Ltd Blockade Medical LLC. D. Yavagal: 2; C; Medtronic. C. Cognard: 2; C; Medtronic, Stryker, Microvention. D. Liebeskind: 2; C; Medtronic, Stryker.