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Objective To report the feasibility of a combined imaging and treatment strategy for acute ischemic stroke (AIS) utilizing a hybrid CT-Angiography suite. Methods A descriptive case report covering the technical aspects of whole-brain vascular and perfusion imaging with a single intra-aortic injection of 7 ml of iodinated contrast for suspected large vessel occlusion (LVO). Results A middle-aged man was transferred after 20-hours with a suspected LVO on imaging. The NIHSS was 12 with right sided hemiplegia and slurred speech. A 5F pigtail catheter was placed in the aortic arch in the hybrid interventional (AlphenixTM) and CT (GenesisTM Aquilion One) suite (Canon Medical Systems, Tustin, CA). A 2-second, intra-aortic injection was performed with 20 ml of 30% contrast-saline mixture at 10 ml/s. Simultaneous triggering of the continuous CT volumetric acquisition was performed with a peak of 80 KVP at a constant 320 mAmp. Volumetric angiography reconstruction of the data set was performed at 0.3s interval (320 images, 0.5 mm thickness with 16cm of coverage). The 12-second single acquisition generated a non-contrast CT of the brain, multiphase angiography at 3 frames/second and whole-brain perfusion imaging (figure 1). The non-contrast CT showed patchy infarcts. The angiography showed a sub-occlusive left MCA thrombus with good collaterals. The perfusion imaging showed matched defects corresponding to the infarcts but no significant penumbral tissue. A standard selective left internal carotid artery catheter angiography confirmed the sub-occlusive thrombus and good collaterals. Repeat on table clinical exam had improved from admission. Given the sub-occlusive thrombus, good collaterals and no at-risk ischemic tissue on perfusion – thrombectomy was not performed. Conclusion Rapid assessment of suspected LVO with simultaneous treatment is feasible in select stroke patients, e.g. transfers, using a hybrid CT-Angiography suite and direct intra-aortic diluted contrast injection. An intra-arterial injection gives superior signal-to-noise ratio and temporal resolution than intravenous injection. Immediate thrombectomy following the acquisition in the same room can shorten door to recanalization times. Disclosures A. Rai: 2; C; Stryker, Microvention, Cerenovus. A. Tarabishy: None. S. Boo: 2; C; STRYKER.

Background It is well known that hyperglycemia is induced by ischemic stroke and causes detrimental outcomes. Hyperglycemia causes neurons to become stunned with the subsequent arrest of protein synthesis and mitochondrial activity. This arrest can lead to cell death following ischemia. What is unknown however is whether normoglycemia following thrombectomy is protective. We proposed that normoglycemia (blood glucose Methods A retrospective cohort study was performed with 187 patients admitted to Ruby Memorial Hospital for acute ischemic stroke and who underwent thrombectomy intervention with or without tPA. Baseline NIHSS and mRS were collected as well diabetes status at time of admission. Glucose levels were recorded within the first 12 hours following thrombectomy. 90 day outcome was grouped into favorable or non-favorable. Analysis was formed by χ2 analysis and student t-tests with p Results Normoglycemia following thrombectomy is an independent risk for favorable 90 day outcome χ2=10.716, p=0.001. The average blood glucose level within 12 hours following thrombectomy for the favorable outcome group was 117 whereas it was 140 for the poor outcome group (t=3.2, p=0.0017). Interestingly, patients with diabetes were not statistically different than patients without diabetes on 90 day outcome results χ2=0.763, p=0.382. 36% of patients with diabetes had favorable outcomes whereas 43.22% of patients without diabetes had favorable outcomes. 91 patients were successfully recanulized and 57.14% had favorable outcomes compared to the 18.87% in the non-recanulized group χ2=21.214, p Conclusions Normoglycemia is an important marker following thrombectomy. If patients have normoglycemia following thrombectomy and recanculization, they are likely to have a favorable long-term course. Hyperglycemia following thrombectomy however is an indication of poor future outcome. Further studies are warranted to elucidate the validity of normoglycemia as a marker for long-term favorable outcome following thrombectomy. Disclosures B. Lucke-Wold: None. S. Boo: None. J. Carpenter: None. A. Tarabishy: None. A. Rai: None.