Abstract TP293: Acute Ischemic Stroke patients with Large Intracranial Vessel Occlusions who do not undergo mechanical thrombectomy.

Introduction: Mechanical thrombectomy (MT) is the standard treatment for Acute ischemic stroke (AIS) patients with large intracranial vessel occlusion (LVO). The TRACE III trial demonstrated that treatment with tenecteplase (TNK) administered within 24 hours after stroke onset improves functional outcome in AIS patients with LVOs who do not undergo MT. TRACE III results are felt to have less impact in the U.S as the majority of AIS with LVO in this country are offered MT. However, the TRACE III results would be relevant to the cohort of LVO patients who do not go to thrombectomy, and therefore we sought to review the reasons AIS patients with LVO are excluded from MT. Methods: During a 2 year period at out academic comprehensive stroke center (CSC) from July 2022 to June 2024, we identified 58 patients with AIS and LVO who did not undergo MT. We excluded AIS who presented > 24 hours from last know normal (LKN), patients with chronic occlusions, and patients who did not have an LVO. LVO was defined as anterior circulation occlusion of the internal carotid artery terminus (ICAT) or the middle cerebral artery (M1 and M2 segments). We performed a retrospective chart review collecting data on demographics, National Institutes of Health Stroke Scale (NIHSS), CT head and neck angiogram findings, thrombolysis administration, and reviewed the reasons documented for not pursuing MT. Results: Among the 58 AIS patients who did not undergo MT, the mean age was 70.8 years (range, 30.8 to 95.0) and 31 (53.4%) were female. The mean NIHSS was 14.1 (range, 0 to 31). The LVO locations included 24 (41.4%) M2, 23 (39.7%) M1, and 11(19.0%) ICAT. Twenty-three patients (39.7%) had a concomitant tandem lesion with cervical carotid occlusion, and 17 (29.3%) of patients received thrombolysis with TNK. The reason for not pursuing thrombectomy were as follows: proximal carotid occlusion in 16 (27.6%), low NIHSS in 13 (22.4%), large core infarct in 9 (15.5%), distal occlusion (M2s) in 8 (13.8%), hemorrhage in 4 (6.9%), poor baseline in 3 (5.2%), and Other in 5 (8.6%). Conclusions: At our academic CSC, the most common reason for excluding LVO stroke patients from thrombectomy include tandem lesions with cervical carotid occlusion, low NIHSS, large core infarcts, and distal occlusion. Understanding the reasons AIS patients with LVOs are excluded from thrombectomy will allow clinicians to identify populations for further clinical study.