Abstract 375: Predictors of Good Clinical Outcomes After First Pass Effect in Anterior Circulation Tandem Occlusions

Introduction First pass effect (FPE) is an independent predictor of good clinical outcomes following mechanical thrombectomy (MT) in non‐tandem occlusions. A proximal tandem carotid steno‐occlusion introduces additional times and technical complexities which can influence recanalization and reperfusion dynamics and potentially, clinical outcomes in the long run. We evaluated the predictors of good clinical outcomes, specifically mRS0‐1 and mRS0‐2 at 90 days, in patients with anterior circulation tandem occlusions where recanalization was achieved through FPE from MT with emergent carotid artery angioplasty and stenting (eCAS), and had a baseline mRS0‐2.; Methods We perform a retrospective analysis of institutional thrombectomy database to identify univariate predictors. Significant predictors will be included in a multivariate logistic regression to determine significant predictors of mRS0‐1 and mRS0‐2 at 90 days post‐MT and eCAS.; Results We included 88 (66.2%) patients who achieved first pass effect among 133 anterior tandem occlusions undergoing MT with eCAS. Among patients with mRS0‐2 at 90 days, multivariate regression identified age (OR:0.857[0.772‐0.952],p=0.004), intravenous alteplase (OR:12.3[1.3‐114],p=0.027), use of a ballon guide catheter as opposed to conventional guides (OR:0.02[0.01‐0.63],p=0.027), time from arterial access to recanalization (OR:0.96[0.92‐0.999],p=0.043), pre‐eCAS oral aspirin/ticagrelor load as opposed to intravenous eptifibatide load (OR:0.017[0.001‐0.964],p=0.048) and symptomatic ICH (OR:0.025[0.001‐0.723],p=0.032) to be significant predictors. Significant predictors for mRS0‐1 at 90‐days were male sex (OR:41.33[1.45‐1179.31],p=0.03), hypertension (OR:0.03[0‐0.44],p=0.012), diabetes (OR:0.04[0‐0.63],p=0.023), use of a ballon guide catheter as opposed to conventional guides (OR:0.03[0‐0.66],p=0.027), distal embolization (OR:0.02[0‐1.71],p=0.082), time from arterial access to recanalization (OR:0.93[0.86‐0.99],p=0.026), residual carotid stenosis after eCAS (OR:0.003[0‐0.18],p=0.005), pre‐eCAS oral aspirin/ticagrelor load as opposed to intravenous eptifibatide load (OR:0.02[0‐0.25],p=0.016) and symptomatic ICH (OR:0.01[0‐0.38],p=0.012). Notably, heparin infusion post procedure predicted improved outcomes but was insignificant (OR: 55.54[0.59‐5226.65],p=0.083).; Conclusion The study highlights important considerations for eCAS, including the choice of antiplatelet loading agent, residual carotid stenosis and longer recanalization times which seem to impact good clinical outcomes.