Abstract 217: Influence of CT Perfusion on Decision‐Making for Endovascular Thrombectomy in Distal Occlusions: A Multi‐center Analysis

Introduction There is increasing interest in performing endovascular thrombectomy (EVT) for distal occlusions. Decision making for distal and medium vessel occlusions (DMVO) is variable and factors associated with undergoing the treatment at present remain incompletely characterized. Methods From our prospectively maintained multi‐center registry encompassing four comprehensive stroke centers in the greater Houston area, we identified patients with DMVO acute ischemic stroke (AIS). Patients with occlusions in and beyond the M2 segment, A2 segment, and P2 segment were included. The primary outcome was the likelihood of undergoing EVT, which was analyzed using multivariable logistic regression. We adjusted for time of day of presentation, NIHSS score, ASPECTS, and TPA administration, with the primary independent variable being whether CTP was used in the patient’s evaluation. Secondary outcomes included discharge modified Rankin Scale (mRS), dichotomized 0‐3 vs. 4‐6 Results Among 269 patients with distal occlusions, the median age was 68 (IQR 18), median NIHSS score was 12 (IQR 11), 47.2% were female, and 39.4% received TPA. The most common occlusion locations were M2 (77.7%) followed by P2 (9.7%), and 12.6% comprised the remainder of the occlusions. 166 (61.7%) underwent CTP and 37.9% underwent EVT. Median infarct core on CTP was 18.8 cc and penumbra was 83.1 cc. In multivariable analysis, patients evaluated with CTP were less likely to undergo EVT (OR 0.56 [95% CI ‐1.11;‐0.02]). CTP usage was also associated with a non‐significant reduced likelihood of good discharge outcome (OR 0.59, [95% CI 0.33;1.02]). Conclusion In our multi‐center cohort, patients with DMVO screened with CTP were nearly 50% less likely to undergo EVT. While the modality may assist with occlusion detection, it may also influence whether treatment is offered.