Abstract WP276: Resource Utilization After Mechanical Thrombectomy: Is ICU Care Required for All Patients?

Background: Mechanical thrombectomy (MT) is the standard of care for qualifying patients with acute ischemic stroke (AIS). Minimal post-procedural guidelines often result in patients being admitted to the intensive care unit (ICU) for 24 hours, even if they did not receive intravenous thrombolysis (IVT). Whether or not these patients consistently utilize ICU resources has not been well studied. This study aims to assess the utilization of ICU resources in post-thrombectomy patients who did not receive IVT. Methods: A retrospective chart review was performed for all AIS patients who were at least 18 years old and received MT from 2015-2022. Patients who received IVT or required ICU-level resources before MT were excluded. ICU-level resources were defined as advanced respiratory support (ARS), neurosurgical intervention, ICU-level infusions (e.g., hypertonic saline, vasoactive, sedating), or interventions requiring ICU-level nursing care. We collected data on patient demographics, stroke characteristics, and the use of ICU-level resources up to 24 hours after MT. A multivariate logistic regression model was used to determine the factors associated with ICU resource utilization. Results: 239 patients met the inclusion criteria. The median admission National Institute of Health Stroke Scale (NIHSS) score was 16. 128 patients (53.6%) did not require ICU resources in the first 24 hours, and 111 (46.4%) did. Vasoactive infusions and ARS were the most utilized resources (n=86; 77.4% and n=55; 49.5%). Vasoactive infusions or ARS during MT were the only statistically significant variables associated with the use of ICU-level resources (OR 2.92, p<0.001 and OR 2.33, p=0.009). Conclusion: Most patients who did not receive IVT do not require ICU resources in the first 24 hours after MT. Multivariate analysis revealed the only statistically significant factors predicting the need for ICU resources was the use of ARS or vasoactive infusions during MT.