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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.

Objective The approval of WEB adds another option for treatment of wide neck bifurcation (WNB) aneurysms. The objective of this study was to compare the procedure times and radiation dose when using WEB versus stent-coil for WNB aneurysms in our early experience. Methods Four procedure variables were analyzed Operating room (OR) time was the duration from patient room arrival to room exit. Anesthesia time was from intubation to extubation. Procedure time was from groin puncture to closure. Radiation exposure was the fluoroscopy time and radiation dose for each procedure. All these were obtained from the procedure logs for 22 patients treated with WEB and 21 patients consecutively treated prior to WEB with stent-coiling. Patients with aneurysms greater than 10 mm in average width were excluded to level the comparison as larger aneurysms requiring more coils could take longer and the upper width size limit for WEB is currently at 10 mm. Results The average width and height of the aneurysms in the two cohorts was similar (Width=5.9(±2.2)mm for the stent-coil versus 5.2(±1.6)mm for the WEB-group, p=0.2; Height=6.8(±3.1)mm for the stent-coil versus 5.8(±1.7)mm for the WEB-group, p=0.2). The OR, anesthesia and procedure times were significantly lower in the WEB-group compared to the stent-coil group (figure-1). The fluoroscopy time and the radiation dose was also significantly lower in the WEB-group versus the stent-coil group (figure-1). Conclusion The use of WEB in WNB aneurysms significantly reduced OR, anesthesia and procedure times versus stent-coiling for similar sized aneurysms. Radiation dose and fluoroscopy times were also significantly reduced. For the WEB group these times are expected to be independent of aneurysm size whereas stent-coiling may be associated with longer times for larger aneurysms. Disclosures A. Rai: 2; C; MicroVention, Stryker. R. Turner: None. S. Boo: 2; C; Stryker.

Introduction Although endovascular thrombectomy (ET) is currently a standard of care in managing acute ischemic stroke, the design of major trials on ET either excluded or under-represented patients older than 80 years old. However, several centers in the US and internationally have expanded the use of ET in the elderly patients often using similar selection criteria to younger patients. In this work, we evaluated functional outcomes, complications, and predictors of outcome after ET in the elderly compared to younger patients. Methods Records of patient undergoing ET for acute ischemic stroke at seven major centers in the United States between January 2013 and December 2017 were retrospectively reviewed for patient characteristics, procedural variables, complications, incidence of post-procedural hemorrhage and functional outcomes measured by 90 day mRS scores. Univariate and multivariate regression analysis were used to compare elderly patients (80 years and older) to younger adults and to determine whether advanced age (≥80 years) is an independent predictor of outcomes of stroke patients undergoing ET. Results A total of 1406 patients (367 patients ≥80 years old) were included in analysis of which 1270 had completed follow-up. Octogenarians had significantly higher percentage of females (65.9% vs 46.3% p 0.05). The median number of comorbidities was 2 in both groups. Procedure variables including procedure time, rate IA-tpa use, final TICI flow, technique used (direct aspiration vs stent retriever), and the rate of complications were not different between the two groups (p>0.05). Elderly patients had a significantly higher median mRS at 90 day follow-up (4 vs 3, p Conclusion Although some randomized controlled trials have provided limited evidence of benefit for using ET in the elderly population, expanding ET to this population in the real-world requires careful refinement of patient selection. This study emphasizes that advanced age coupled to higher NIHSS on admission and an anticipated long procedure should prompt careful discussion of the risks and benefits of ET in the elderly. Disclosures A. Alawieh: None. R. Starke: None. A. Chatterjee: None. A. Turk: None. R. De Leacy: None. A. Rai: 2; C; Stryker. K. Fargen: None. P. Kan: 2; C; Medtronics, Stryker. J. Singh: None. L. Vilella: None. F. Nascimento: None. T. Dumont: None. A. Spiotta: 1; C; Penumbra, Pulsar Vascular, Microvention, Stryker,. 2; C; Penumbra, Pulsar Vascular, Microvention, 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.