Introduction: Endovascular Therapy(EVT) has been shown to be efficacious for treatment of large artery occlusion (LAO) acute ischemic stroke (AIS). The 2018 American Heart Association Guidelines for Management of Acute Ischemic Stroke recommend EVT for patients with anterior circulation LAO AIS with ASPECTS ≥6 and groin puncture within 6 hours of symptom onset. CT Perfusion (CTP) pattern with CBF < 30% of ≥ 70cc is a predictor of a large core infarction. Patients within 6 hours of symptom onset with LAO AIS with favorable ASPECTS on non-contrast head CT and large core infarct measurements on CTP may present a decision-making challenge. Hypothesis: CTP CBF < 30% of ≥ 70cc predicts poor functional outcome in anterior circulation LAO AIS with ASPECTS ≥6 with groin puncture for EVT within 6 hours of symptom onset. Methods: From a large healthcare system’s stroke network database, we conducted a retrospective analysis of functional outcomes (90 day mRS) of patients who presented with LAO AIS with ASPECTS ≥6 with CBF < 30% of ≥ 70cc who underwent EVT with groin puncture within 6 hours from symptom onset between July 2016 and March 2018. Results: Over a 21-month period, 12 cases were identified with CBF < 30% ≥ 70cc and ASPECTS ≥ 6 who underwent EVT within 6 hours of symptom onset. Mean and median CBF < 30% were 119.8 cc and 99 cc, while mean and median ASPECTS scores were 9.3 and 10. TICI 3 revascularization was achieved in 6 patients, and TICI 2B was achieved in 3 patients, within one patient each achieving TICI 2A, TICI 1 and TICI 0. Mean and median mRS at discharge were 4.2 and 4, while mean and median 90 day mRS were 4 and 3. Of the five patients who died, none sustained parenchymal type 2 hemorrhages, and two had TICI 2B, two had TICI 3, one had TICI 0 revascularization. Conclusions: In our experience, most patients presenting within 6 hours of symptom onset with a CBF < 30% of ≥ 70cc and an ASPECTS ≥6 achieved poor functional outcomes (mRS of >2) despite overall good rates of revascularization.

To report a single-center experience of the technical success and clinical 90-day outcomes of MT for anterior circulation ELVOs performed by interventional radiologists. Materials: A retrospective review identified 178 consecutive patients from January 2016 to March 2018 who underwent MT for anterior circulation ELVOs within 6 hours of symptom onset and initial NCCT ASPECTS 6, or presenting >6 hours but further selected with CT perfusion. Eight interventional radiologists performed the procedures. Technical and clinical outcomes were compared to the HERMES dataset. Results: Eight patients were excluded for spontaneous revascularization. The average age was 66 years versus 68 years for HER-MES. The average NIHSS was 17 for both groups. Vessel occlusions included: M1 59% (100/170) versus 69% (439/633), M2 12% (20/ 170) versus 8.0% (51/633), ICA 29% (50/170) versus 21% (133/ 633), and tandem ICA origin/M1 17% (29/170) (not reported in all trials), respectively. The overall mTICI 2b/3 reperfusion rate was 87% (148/170) versus 72% (405/633), respectively (p<0.05). The mRS 90-day outcome 0-2 rate was 40% (68/170) versus 46% (223/ 645), respectively (p¼0.14). Major procedural complications were 3.5% (6/171) including 2 ICA dissections, 1 M2 MCA air embolization, 1 MCA wire perforation, 1 femoral hematoma requiring transfusion, and 1 anaphylaxis. Symptomatic intracranial hemorrhage rate was 4.1% (7/171) versus 4.4% (28/633), respectively. Conclusions: This single-center experience describes similar technical success and 90-day outcomes for MT of anterior ELVOs by interventional radiologists to the HERMES data set.