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Background and purpose Previous studies suggest that mechanisms and outcomes in patients with COVID-19-associated stroke differ from those in patients with non-COVID-19-associated strokes, but there is limited comparative evidence focusing on these populations. The aim of this study, therefore, was to determine if a significant association exists between COVID-19 status with revascularization and functional outcomes following thrombectomy for large vessel occlusion (LVO), after adjustment for potential confounding factors. Methods A cross-sectional, international multicenter retrospective study was conducted in consecutively admitted COVID-19 patients with concomitant acute LVO, compared to a control group without COVID-19. Data collected included age, gender, comorbidities, clinical characteristics, details of the involved vessels, procedural technique, and various outcomes. A multivariable-adjusted analysis was conducted. Results In this cohort of 697 patients with acute LVO, 302 had COVID-19 while 395 patients did not. There was a significant difference (p < 0.001) in the mean age (in years) and gender of patients, with younger patients and more males in the COVID-19 group. In terms of favorable revascularization (modified Thrombolysis in Cerebral Infarction [mTICI] grade 3), COVID-19 was associated with lower odds of complete revascularization (odds ratio 0.33, 95% confidence interval [CI] 0.23-0.48; p < 0.001), which persisted on multivariable modeling with adjustment for other predictors (adjusted odds ratio 0.30, 95% CI 0.12-0.77; p = 0.012). Moreover, endovascular complications, in-hospital mortality, and length of hospital stay were significantly higher among COVID-19 patients (p < 0.001). Conclusion COVID-19 was an independent predictor of incomplete revascularization and poor functional outcome in patients with stroke due to LVO. Furthermore, COVID-19 patients with LVO were more often younger and had higher morbidity/mortality rates.

BackgroundThe mechanisms and outcomes in coronavirus disease (COVID-19)-associated stroke are unique from those of non-COVID-19 stroke.ObjectiveTo describe the efficacy and outcomes of acute revascularization of large vessel occlusion (LVO) in the setting of COVID-19 in an international cohort.MethodsWe conducted an international multicenter retrospective study of consecutively admitted patients with COVID-19 with concomitant acute LVO across 50 comprehensive stroke centers. Our control group constituted historical controls of patients presenting with LVO and receiving a mechanical thrombectomy between January 2018 and December 2020.ResultsThe total cohort was 575 patients with acute LVO; 194 patients had COVID-19 while 381 patients did not. Patients in the COVID-19 group were younger (62.5 vs 71.2; P < .001) and lacked vascular risk factors (49, 25.3% vs 54, 14.2%; P = .001). Modified thrombolysis in cerebral infarction 3 revascularization was less common in the COVID-19 group (74, 39.2% vs 252, 67.2%; P < .001). Poor functional outcome at discharge (defined as modified Ranklin Scale 3-6) was more common in the COVID-19 group (150, 79.8% vs 132, 66.7%; P = .004). COVID-19 was independently associated with a lower likelihood of achieving modified thrombolysis in cerebral infarction 3 (odds ratio [OR]: 0.4, 95% CI: 0.2-0.7; P < .001) and unfavorable outcomes (OR: 2.5, 95% CI: 1.4-4.5; P = .002).ConclusionCOVID-19 was an independent predictor of incomplete revascularization and poor outcomes in patients with stroke due to LVO. Patients with COVID-19 with LVO were younger, had fewer cerebrovascular risk factors, and suffered from higher morbidity/mortality rates.

BackgroundTo analyse the clinical characteristics of COVID-19 with acute ischaemic stroke (AIS) and identify factors predicting functional outcome.MethodsMulticentre retrospective cohort study of COVID-19 patients with AIS who presented to 30 stroke centres in the USA and Canada between 14 March and 30 August 2020. The primary endpoint was poor functional outcome, defined as a modified Rankin Scale (mRS) of 5 or 6 at discharge. Secondary endpoints include favourable outcome (mRS ≤2) and mortality at discharge, ordinal mRS (shift analysis), symptomatic intracranial haemorrhage (sICH) and occurrence of in-hospital complications.ResultsA total of 216 COVID-19 patients with AIS were included. 68.1% (147/216) were older than 60 years, while 31.9% (69/216) were younger. Median [IQR] National Institutes of Health Stroke Scale (NIHSS) at presentation was 12.5 (15.8), and 44.2% (87/197) presented with large vessel occlusion (LVO). Approximately 51.3% (98/191) of the patients had poor outcomes with an observed mortality rate of 39.1% (81/207). Age >60 years (aOR: 5.11, 95% CI 2.08 to 12.56, pConclusionThere is relationship between COVID-19-associated AIS and severe disability or death. We identified several factors which predict worse outcomes, and these outcomes were more frequent compared to global averages. We found that elevated neutrophil-to-lymphocyte ratio, rather than D-Dimer, predicted both morbidity and mortality.

The COVID-19 pandemic has accelerated neurological, mental health disorders, and neurocognitive issues. However, there is a lack of inexpensive and efficient brain evaluation and screening systems. As a result, a considerable fraction of patients with neurocognitive or psychobehavioral predicaments either do not get timely diagnosed or fail to receive personalized treatment plans. This is especially true in the elderly populations, wherein only 16% of seniors say they receive regular cognitive evaluations. Therefore, there is a great need for development of an optimized clinical brain screening workflow methodology like what is already in existence for prostate and breast exams. Such a methodology should be designed to facilitate objective early detection and cost-effective treatment of such disorders. In this paper we have reviewed the existing clinical protocols, recent technological advances and suggested reliable clinical workflows for brain screening. Such protocols range from questionnaires and smartphone apps to multi-modality brain mapping and advanced imaging where applicable. To that end, the Society for Brain Mapping and Therapeutics (SBMT) proposes the Brain, Spine and Mental Health Screening (NEUROSCREEN) as a multi-faceted approach. Beside other assessment tools, NEUROSCREEN employs smartphone guided cognitive assessments and quantitative electroencephalography (qEEG) as well as potential genetic testing for cognitive decline risk as inexpensive and effective screening tools to facilitate objective diagnosis, monitor disease progression, and guide personalized treatment interventions. Operationalizing NEUROSCREEN is expected to result in reduced healthcare costs and improving quality of life at national and later, global scales.

Background Acute ischemic stroke (AIS) in the context of COVID‐19 has received considerable attention for its propensity to affect patients of all ages. We aimed to evaluate the effect of age on functional outcome and mortality following an acute ischemic event. Methods and Results A prospectively maintained database from comprehensive stroke centers in Canada and the United States was analyzed for patients with AIS from March 14 to September 30, 2020 who tested positive for SARS‐CoV‐2. The primary outcome was Modified Rankin Scale score at discharge, and the secondary outcome was mortality. Baseline characteristics, laboratory values, imaging, and thrombectomy workflow process times were assessed. Among all 126 patients with COVID‐19 who were diagnosed with AIS, the median age was 63 years (range, 27–94). There were 35 (27.8%) patients with AIS in the aged ≤55 years group, 47 (37.3%) in the aged 56 to 70 group, and 44 (34.9%) in the aged >70 group. Intravenous tissue plasminogen activator and thrombectomy rates were comparable across these groups, ( P =0.331 and 0.212, respectively). There was a significantly lower rate of mortality between each group favoring younger age (21.9% versus 45.0% versus 48.8%, P =0.047). After multivariable adjustment for possible confounders, a 1‐year increase in age was significantly associated with fewer instances of a favorable outcome of Modified Rankin Scale 0 to 2 (odds ratio [OR], 0.95; 95 CI%, 0.90–0.99; P =0.048) and higher mortality (OR, 1.06; 95 CI%, 1.02–1.10; P =0.007). Conclusions AIS in the context of COVID‐19 affects young patients at much greater rates than pre‐pandemic controls. Nevertheless, instances of poor functional outcome and mortality are closely tied to increasing age.

Objective: To determine the safety and efficacy of flow reversal following proximal flow arrest as an embolic protection strategy for carotid angioplasty and stenting (CAS) with short-term follow-up. Method: We performed a retrospective review of our CAS database for patients who underwent stent-supported carotid revascularization in the setting of acute/subacute stroke or TIA. We reviewed clinical and radiographic data during a 36-month period. Primary outcome was clinical evidence of ipsilateral stroke in the first 30 days. Secondary outcomes include clinical outcomes and sonographic and/or angiographic follow-up over 6 months, 6-month functional scale, and all-cause mortality. Results: Fifty-five patients underwent CAS using flow reversal: 26 females and 29 males with a mean age of 69.7 years. Median time to treatment from index event was 3 days. 11% underwent stenting as part of hyperacute stroke therapy. Average luminal stenosis was 86%. The 9-Fr Mo.Ma device was used in combination with Penumbra aspiration in all cases. There were no ipsilateral strokes. Incidence of any ischemic event was 3.64%, but only 1 (1.82%) patient had a postoperative stroke. Clinical follow-up was available for 94.5%, while lesion follow-up was available for 73% of patients. Three patients had evidence of restenosis, but none were symptomatic. Luminal restenosis was ≤30% in all three. Median pre- and post-NIHSS were 1 and 1, respectively. Conclusion: Flow reversal using the Mo.Ma device is a safe and effective strategy in preventing distal embolization during carotid artery revascularization.

BackgroundThe neutrophil–lymphocyte ratio (NLR) is emerging as an important biomarker of acute physiologic stress in a myriad of medical conditions, and is a confirmed poor prognostic indicator in COVID-19.ObjectiveWe sought to describe the role of NLR in predicting poor outcome in COVID-19 patients undergoing mechanical thrombectomy for acute ischemic stroke.MethodsWe analyzed NLR in COVID-19 patients with large vessel occlusion (LVO) strokes enrolled into an international 12-center retrospective study of laboratory-confirmed COVID-19, consecutively admitted between March 1, 2020 and May 1, 2020. Increased NLR was defined as ≥7.2. Logistic regression models were generated.ResultsIncidence of LVO stroke was 38/6698 (.57%). Mean age of patients was 62 years (range 27–87), and mortality rate was 30%. Age, sex, and ethnicity were not predictive of mortality. Elevated NLR and poor vessel recanalization (Thrombolysis in Cerebral Infarction (TICI) score of 1 or 2a) synergistically predicted poor outcome (likelihood ratio 11.65, p = .003). Patients with NLR > 7.2 were 6.8 times more likely to die (OR 6.8, CI95% 1.2–38.6, p = .03) and almost 8 times more likely to require prolonged invasive mechanical ventilation (OR 7.8, CI95% 1.2–52.4, p = .03). In a multivariate analysis, NLR > 7.2 predicted poor outcome even when controlling for the effect of low TICI score on poor outcome (NLR p = .043, TICI p = .070).ConclusionsWe show elevated NLR in LVO patients with COVID-19 portends significantly worse outcomes and increased mortality regardless of recanalization status. Severe neuro-inflammatory stress response related to COVID-19 may negate the potential benefits of successful thrombectomy.

Background: While there are reports of acute ischemic stroke (AIS) in COVID-19 patients, the overall incidence of acute ischemic stroke and clinical characteristics of large vessel occlusion in such patient remains to be established. Methods: A retrospective, international multicenter study of large vessel occlusion (LVO) was undertaken from March 1 to May 1, 2020 at 12 stroke centers from 4 countries. Detailed data were collected on consecutive LVOs in hospitalized patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the incidence of AIS/LVO was measured. Among patients who underwent mechanical thrombectomy, stroke outcomes along with COVID-19 symptoms were reported. Results: Out of a total of 6698 COVID-19 patients admitted to 10 stroke centers, the incidence of stroke was found to be 1.3% (range 0.6-2.6%). The median age of patients who presented with LVO was 51 years (range 27-87) and in the US centers, African Americans comprised 28% of all patients. Ten patients (16 %) were less than 50 years of age with no significant risk factors for LVOs the vast majority. Among the LVOs eligible for MT, the average time to presentation from symptom onset to presentation was 9.3 hours. Successful revascularization was achieved in 81% of patients and the intracranial hemorrhage rate was 14% with no symptomatic hemorrhages. Twenty-one (50%) patients were either discharged to home or to acute rehabilitation facilities. Conclusion: LVOs was predominant in patients with AIS and COVID-19, occurring at a significantly younger age and affecting African Americans disproportionately.

Introduction: Underlying biological, genetic, or epigenetic characteristics may predispose to health differences and outcomes with COVID-19 associated stroke. Social determinants of health, access and geographical differences pertaining both to population density and other location-based factors may also be important. Methods: We report 69 cases of acute stroke in patients positive for SARS-CoV-2, in a dichotomized analysis of ischemic stroke outcomes between patients of African American background versus all other backgrounds. All patients presented to 14 major hospitals in the United States and Canada, from March 14-April 14, 2020. All patients had nasopharyngeal swab samples that were positive for SARS-CoV-2 on qualitative RT-PCR assays. Results: We found no significant difference in age (64.4 versus 62.9 years) or the proportion of females (51.9% versus 38.1%) (table 1). Diabetes mellitus was present significantly less in African American cases versus others (37% vs. 66.7%). The African American cohort had a similar mean NIHSS score of 16.3 compared with 14.9 in other races (p=0.63). The door-to-CT time was also similar (23 versus 19 minutes). The proportion of patients presenting with a large vessel occlusion was not significantly different (40.7% versus 47%). We noted 14.8% of African American cases received intravenous tPA compared to 31% in other races but was not significantly different. The proportion of thrombectomy cases mirrored this (14.8% versus 31%). Regarding stroke functional outcomes, there was no difference between African Americans and other races with respect to discharge mRS or proportion of favorable outcome (mRS 0-2). Symptomatic intracranial hemorrhage (sICH) was significantly higher for African Americans (11.1% versus 3%, p Discussion: The reasons for increased mortality in African Americans with COVID-19-associated stroke are unknown. The finding in this study that mortality rate of COVID-19 positive stroke patients is greater than that previously reported in either COVID-19 respiratory infection alone or acute ischemic stroke alone, suggests an interaction that also warrants further study.

Objective: To study the efficacy of middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematoma (SDH) and characterize its post-embolization volumetric resolution. Methods: Ten patients diagnosed with 13 cSDH underwent MMA embolization. SDH volumes were measured from time of initial discovery on imaging to pre-operative, post-operative, short-term and long-term follow-up. Time between procedure to obliteration was also measured. Volumetric analysis was done using the coniglobus formula, and recurrence rate as well as resolution timeline was defined using best-fit models. Results: Out of 10 patients, five were recurrent lesions, three were bilateral and seven unilateral cSDH. Average and median pre-operative volumes were 105.3 cc and 97.4 cc, respectively. Embolization on average was performed 21 days after discovery. Sixty percent of patients had concurrent antiplatelets or anticoagulation use. Forty percent underwent embolization treatment as the primary therapy. Recurrence was not seen in any patients treated with embolization. There were no peri- or post-operative complications. Five patients experienced complete or near-complete obliteration, while those with partial resolution showed a composite average of 75% volumetric reduction in 45 days. Post-embolization, the volumetric resolution followed an exponential decay curve over time and was independent of initial volume. Conclusion: MMA embolization contributed to a marked reduction in SDH volume post-operatively and can be used as a curative therapy for primary or recurrent chronic SDH.

BACKGROUND AND PURPOSE: Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is associated with hypercoagulability. We sought to evaluate the demographic and clinical characteristics of cerebral venous thrombosis among patients hospitalized for coronavirus disease 2019 (COVID-19) at 6 tertiary care centers in the New York City metropolitan area. MATERIALS AND METHODS: We conducted a retrospective multicenter cohort study of 13,500 consecutive patients with COVID-19 who were hospitalized between March 1 and May 30, 2020. RESULTS: Of 13,500 patients with COVID-19, twelve had imaging-proved cerebral venous thrombosis with an incidence of 8.8 per 10,000 during 3 months, which is considerably higher than the reported incidence of cerebral venous thrombosis in the general population of 5 per million annually. There was a male preponderance (8 men, 4 women) and an average age of 49 years (95% CI, 36–62 years; range, 17–95 years). Only 1 patient (8%) had a history of thromboembolic disease. Neurologic symptoms secondary to cerebral venous thrombosis occurred within 24 hours of the onset of the respiratory and constitutional symptoms in 58% of cases, and 75% had venous infarction, hemorrhage, or both on brain imaging. Management consisted of anticoagulation, endovascular thrombectomy, and surgical hematoma evacuation. The mortality rate was 25%. CONCLUSIONS: Early evidence suggests a higher-than-expected frequency of cerebral venous thrombosis among patients hospitalized for COVID-19. Cerebral venous thrombosis should be included in the differential diagnosis of neurologic syndromes associated with SARS-CoV-2 infection.

COVID-19 is a severe infectious disease that has claimed >150,000 lives and infected millions in the United States thus far, especially the elderly population. Emerging evidence has shown the virus to cause hemorrhagic and immunologic responses, which impact all organs, including lungs, kidneys, and the brain, as well as extremities. SARS-CoV-2 also affects patients’, families’, and society’s mental health at large. There is growing evidence of re-infection in some patients. The goal of this paper is to provide a comprehensive review of SARS-CoV-2-induced disease, its mechanism of infection, diagnostics, therapeutics, and treatment strategies, while also focusing on less attended aspects by previous studies, including nutritional support, psychological, and rehabilitation of the pandemic and its management. We performed a systematic review of >1,000 articles and included 425 references from online databases, including, PubMed, Google Scholar, and California Baptist University’s library. COVID-19 patients go through acute respiratory distress syndrome, cytokine storm, acute hypercoagulable state, and autonomic dysfunction, which must be managed by a multidisciplinary team including nursing, nutrition, and rehabilitation. The elderly population and those who are suffering from Alzheimer’s disease and dementia related illnesses seem to be at the higher risk. There are 28 vaccines under development, and new treatment strategies/protocols are being investigated. The future management for COVID-19 should include B-cell and T-cell immunotherapy in combination with emerging prophylaxis. The mental health and illness aspect of COVID-19 are among the most important side effects of this pandemic which requires a national plan for prevention, diagnosis and treatment.

IntroductionThere has been limited evidence on the influence of racial background in stroke outcomes in COVID-19 Underlying biological, genetic, or epigenetic characteristics may predispose to health differences and outcomes Social determinants of health, access and geographical differences pertaining both to population density and other location-based factors may also be important MethodsWe report 69 cases of acute stroke in patients positive for SARS-CoV-2, including 27 of African American background and 42 of other racial backgrounds, including Caucasian, Hispanic, and Asian All patients presented to 14 major hospitals in the United States and Canada, from March 14-April 14, 2020 All patients had nasopharyngeal swab samples that were positive for SARS-CoV-2 on qualitative RT-PCR assays We present a dichotomized analysis of ischemic stroke outcomes between patients of African American background as reported on hospital intake questionnaire versus all other backgrounds ResultsComparison between Caucasian, Hispanic and Asian backgrounds did not show disparities in stroke outcomes We found no significant difference in age (64 4 versus 62 9 years) or the proportion of females (51 9% versus 38 1%) (table 1) Diabetes mellitus was present significantly less in African American cases versus others (37% vs 66 7%) No significant difference between groups was found regarding other comorbidities including smoking, atrial fibrillation, prior anticoagulation, coronary artery disease, congestive heart failure, hypertension, hyperlipidemia, cerebrovascular accident, peripheral vascular disease, or chronic kidney disease With respect to presenting SARS-CoV-2 symptoms, we found no difference in exposure history, asymptomatic cases, fever, cough, dyspnea, nausea or vomiting, chills, malaise, or lethargy The African American cohort had a similar mean NIHSS score of 16 3 compared with 14 9 in other races (p=0 63) The door-to-CT time was also similar (23 versus 19 minutes) The proportion of patients presenting with a large vessel occlusion was not significantly different (40 7% versus 47%) We noted 14 8% of African American cases received intravenous tPA compared to 31% in other races, but this was not significantly different in this sample The proportion of thrombectomy cases mirrored this (14 8% versus 31%) Laboratory findings were not significantly different between African Americans and all others Regarding stroke functional outcomes, there was no difference between African Americans and other races in terms of discharge mRS (p=0 27) For mRS 0–2, there was no significant difference noted (14 8% versus 16 7%) Symptomatic intracranial hemorrhage (sICH) was significantly higher for African Americans (11 1% versus 3%, p0 001) Mortality was significantly higher in African Americans compared to other races (51 9% vs 28 6%, p=0 03) DiscussionOur preliminary data suggest that there may be a mortality difference amongst stroke patients of African American background afflicted with COVID-19 The reasons for increased mortality in African Americans with COVID-19-associated stroke are unknown Racial disparities in case counts and outcomes during the COVID-19 pandemic have been highlighted, particularly regarding African American communities In addition, the finding in this study that mortality rate of COVID-19 positive stroke patients is greater than that previously reported in either COVID-19 respiratory infection alone or acute ischemic stroke alone, suggests an interaction that also warrants further study DisclosuresA Dmytriw: None K Phan: None C Schirmer: None F Settecase: None M Heran: None A Efendizade: None A Kuhn: None A Puri: None B Menon: None M Dibas: None S Sivakumar: None A Mowla: None L Leung: None A Malek: None B Voetsch: None S Segal: None A Wakhloo: None H Wu: None A Xavier: None A Tiwari: None

A retrospective study from the COVID-19 outbreak in Wuhan, China demonstrated an incidence of acute ischaemic stroke of approximately 5% in hospitalised patients with severe disease.1 However, there has been limited evidence on the influence of racial background in stroke outcomes in this pandemic. We report 69 cases of acute stroke in patients positive for SARS-CoV-2, including 27 of African–American background and 42 of other racial backgrounds, including Caucasian, Hispanic and Asian. All patients presented to 14 major hospitals in the USA and Canada, from 14 March 2020 to 14 April 2020. The study was maintained under IRB #s20-00765. All patients had nasopharyngeal swab samples that were positive for SARS-CoV-2 on qualitative reverse-transcriptase-PCR assays. In the following, we present a dichotomised analysis of ischaemic stroke outcomes between patients of African–American background as reported on hospital intake questionnaire versus patients of all other backgrounds. All variables stratified to race (African–American vs others). For continuous variables, when the data are normal, t-test was used and data were presented in the form of mean (SD). If they were not normally distributed, the Wilcoxon rank-sum test was used and the …

Background and Purpose The coronavirus disease-2019 (COVID-19) pandemic caused unprecedented demand and burden on emergency health care services in New York City. We aim to describe our experience providing acute stroke care at a comprehensive stroke center (CSC) and the impact of the pandemic on the quality of care for patients presenting with acute ischemic stroke (AIS). Methods We retrospectively analyzed data from a quality improvement registry of consecutive AIS patients at New York University Langone Health's CSC between 06/01/2019-05/15/2020. During the early stages of the pandemic, the acute stroke process was modified to incorporate COVID-19 screening, testing, and other precautionary measures. We compared stroke quality metrics including treatment times and discharge outcomes of AIS patients during the pandemic (03/012020-05/152020) compared with a historical pre-pandemic group (6/1/2019-2/29/2020). Results A total of 754 patients (pandemic-120; pre-pandemic-634) were admitted with a principal diagnosis of AIS; 198 (26.3%) received alteplase and/or mechanical thrombectomy. Despite longer median door to head CT times (16 vs 12 minutes; p = 0.05) and a trend towards longer door to groin puncture times (79.5 vs. 71 min, p = 0.06), the time to alteplase administration (36 vs 35 min; p = 0.83), door to reperfusion times (103 vs 97 min, p = 0.18) and defect-free care (95.2% vs 94.7%; p = 0.84) were similar in the pandemic and pre-pandemic groups. Successful recanalization rates (TICI≥2b) were also similar (82.6% vs. 86.7%, p = 0.48). After adjusting for stroke severity, age and a prior history of transient ischemic attack/stroke, pandemic patients had increased discharge mortality (adjusted OR 2.90 95% CI 1.77 – 7.17, p = 0.021) Conclusion Despite unprecedented demands on emergency healthcare services, early multidisciplinary efforts to adapt the acute stroke treatment process resulted in keeping the stroke quality time metrics close to pre-pandemic levels. Future studies will be needed with a larger cohort comparing discharge and long-term outcomes between pre-pandemic and pandemic AIS patients.

ObjectiveTo describe the ischemic stroke subtypes related to COVID-19 in a cohort of NYC hospitals and explore their etiopathogenesis.BackgroundExtra-pulmonary involvement of COVID-19 has been reported in the hepatic, renal and hematological systems. Most neurological manifestations are non-focal, but few have reported the characteristics of ischemic strokes or investigated its pathophysiology.MethodsData were collected prospectively from March 15 to April 15, 2020 from four centers in New York City to review possible ischemic stroke types seen in COVID-19 positive patients. Patient presentation, demographics, other related vascular risk factors, associated laboratory and coagulation markers, as well as imaging and outcomes for consecutive stroke patients positive for SARS-COV2 infection over the period studied were collected.ResultsIn our study, the age range of patients was 25-75 with no significant male preponderance. The median age of LVO patients was 48. Stroke was the presenting and hospitalizing event in 70%. One fifth of patients did not have common risk factors for ischemic stroke and none had atrial fibrillation, coronary or cerebrovascular disease, or were smokers. Half had a poor outcome with 40% ending in mortality (60% in LVO group) and one in a critical condition due ARDS. All had high neutrophil/lymphocyte ratio except one who demonstrated some neurological recovery. D-dimer levels showed mild to severe elevation when collected. None of the LVO cases had known cardiac risk factors but two out of five were found to have cardiac abnormalities during their hospitalization. All LVOs had hypercoagulable lab markers especially elevated D-dimer and/or fibrinogen. The LVO patients were younger and sicker with a median age of 46 and mean NIHSS of 24 as opposed to non-LVOs with a median age of 62 and mean NIHSS of 6 respectively.ConclusionCOVID-19 related ischemic events can be small vessel, branch emboli or large vessel occlusions. The latter is often associated with either a hypercoagulable state or cardio-embolism. Patient outcomes were worse when multi-organ or pulmonary system failure prevailed.

BACKGROUND AND PURPOSE Mechanical thrombectomy (MT) has helped many patients achieve functional independence. The effect of time-to-treatment based in specific epochs and as related to Alberta Stroke Program Early CT Score (ASPECTS) has not been established. The goal of the study was to evaluate the association between last known normal (LKN)-to-puncture time and good functional outcome. METHODS We conducted a retrospective cohort study of prospectively collected acute ischemic stroke patients undergoing MT for large vessel occlusion. We used binary logistic regression models adjusted for age, Modified Treatment in Cerebral Ischemia score, initial National Institutes of Health Stroke Scale, and noncontrast CT ASPECTS to assess the association between LKN-to-puncture time and favorable outcome defined as Modified Rankin Score 0-2 on discharge. RESULTS Among 421 patients, 328 were included in analysis. Increased LKN-to-puncture time was associated with decreased probability of good functional outcome (adjusted odds ratio [aOR] ratio per 15-minute delay = .98; 95% confidence interval [CI], .97-.99; P = .001). This was especially true when LKN-puncture time was 0-6 hours (aOR per 15-minute delay = .94; 95% CI, .89-.99; P = .05) or ASPECTS 8-10 (aOR = .98; 95% CI, .97-.99; P = .002) as opposed to when LKN-puncture time was 6-24 hours (aOR per 15-minute delay = .99; 95% CI, .97-1.00; P = .16) and ASPECTS

Introduction: Thrombectomy for acute ischemic stroke with large vessel occlusion is a highly effective therapy. However, meta-analyses of seminal trials show as many as 54% of thrombectomy patients do not achieve functional independence at 90 days (Goyal et al, Lancet 2016) and 72% of patients do not get discharged to home (Jahan et al, NEJM 2019). Here we investigate technical factors associated with maximizing the likelihood of good discharge outcome. Specifically, we evaluated how thrombectomy technique (clot suction alone, stentretriever alone, or combination therapy with both) and reperfusion grade (partial TICI 2b or complete TICI 3) affected the likelihood of good outcome defined as discharge to home or acute rehab. Methods: Retrospective data from 15 hospitals were used including patients age 18 or over discharged from January 2014 to May 2019 with a primary or secondary diagnosis of ischemic stroke who received a thrombectomy and achieved TICI reperfusion grade of 2b or 3. Primary outcome was discharge to home or inpatient rehabilitation (IRF) versus other discharge dispositions, including death. Multivariate logistic regression was used to determine if TICI 3 versus TICI 2b and/or procedure technique (retrievable stent only, distal aspiration only or a combination approach with both) were associated with better outcome of discharge to home/IRF, adjusting for age, race, medical history, and NIHSS at admission. Main effects and interaction between technique and TICI were included in the model. Results: The analysis included 787 patients, 55.3% (n=435) were discharged home/IRF and 44.7% (n=352) were discharged elsewhere or expired. Patients with TICI 3 grade were more likely to be discharged to home/IRF compared to those with TICI 2b (Adjusted Odds Ratio (AOR)=1.35, p=.018). Those who received distal aspiration only (AOR=1.87. p Conclusion: Our analysis suggested that both TICI grade 3 and distal aspiration or combination approach techniques independently predicted more favorable disposition outcome.

Introduction: Prior randomized trials have defined substantial reperfusion for stroke thrombectomy as TICI 2b or TICI 3. However, recent data suggest that complete TICI 3 reperfusion results in more favorable patient outcomes than partial reperfusion with TICI 2b. We have multiple effective techniques for thrombectomy, but it is not clear which are most likely to achieve TICI 3 rather than TICI 2b reperfuson. Methods: Retrospective data from 15 hospitals were used for patients age 18 or over discharged from January 2014 to May 2019 with a primary or secondary diagnosis of ischemic stroke who received a thrombectomy and achieved TICI reperfusion grade of 2b or 3. Primary outcome was TICI grade 3, defined as complete reperfusion, versus TICI 2b. Multivariate logistic regression was conducted to determine if procedure technique (retrievable stent only, distal aspiration only or a combination approach with both) was associated with achieving TICI 3 versus 2b adjusting for sex, age ≥70 vs ≤69, race/ethnicity, history of chronic renal insufficiency or diabetes, history or newly diagnosed atrial fibrillation or flutter, previous anticoagulation medication. Interaction effects between technique and clinical variables were also tested. Results: The analysis included 787 patients, 67.9% (n=534) TICI 3 and 32.1% (n=253) TICI 2b. While, main effect of procedure technique was not a significant predictor of achieving TICI 3 (p=.451), interaction effects showed superiority of the combination approach in several patient populations. Specifically, the combined approach increased the likelihood of TICI 3 compared to stent retrieval alone for older patients (Adjusted Odds Ratio (AOR) =1.79, p=.007), those with a history of diabetes (AOR=1.56, p=.045) and Asian patients (AOR=4.41, p=.010). Among AFIB/flutter patients, the combined approach also increased the odds of complete reperfusion compared to stent retriever alone (AOR=1.76, p=.005) or distal aspiration alone (AOR=1.38, p=.034). Conclusion: The combined approach of retrievable stent and distal aspiration was a significant predictor of achieving TICI 3 in certain patient subgroups including patients who were older, Asian, had a history of diabetes or history of or current AFIB/flutter.

Importance: Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), is a global pandemic that has been an i

BACKGROUND While there are reports of acute ischemic stroke (AIS) in coronavirus disease 2019 (COVID-19) patients, the overall incidence of AIS and clinical characteristics of large vessel occlusion (LVO) remain unclear. OBJECTIVE To attempt to establish incidence of AIS in COVID-19 patients in an international cohort. METHODS A cross-sectional retrospective, multicenter study of consecutive patients admitted with AIS and COVID-19 was undertaken from March 1 to May 1, 2020 at 12 stroke centers from 4 countries. Out of those 12 centers, 9 centers admitted all types of strokes and data from those were used to calculate the incidence rate of AIS. Three centers exclusively transferred LVO stroke (LVOs) patients and were excluded only for the purposes of calculating the incidence of AIS. Detailed data were collected on consecutive LVOs in hospitalized patients who underwent mechanical thrombectomy (MT) across all 12 centers. RESULTS Out of 6698 COVID-19 patients admitted to 9 stroke centers, the incidence of stroke was found to be 1.3% (interquartile range [IQR] 0.75%-1.7%). The median age of LVOs patients was 51 yr (IQR 50-75 yr), and in the US centers, African Americans comprised 28% of patients. Out of 66 LVOs, 10 patients (16%) were less than 50 yr of age. Among the LVOs eligible for MT, the average time from symptom onset to presentation was 558 min (IQR 82-695 min). A total of 21 (50%) patients were either discharged to home or discharged to acute rehabilitation facilities. CONCLUSION LVO was predominant in patients with AIS and COVID-19 across 2 continents, occurring at a significantly younger age and affecting African Americans disproportionately in the USA., Graphical Abstract Graphical Abstract

Consider stenting of the proximal subclavian artery to correct symptomatic subclavian steal syndrome due to dialysis arteriovenous fistula.

Introduction: Direct comparisons of stroke risk factors and rates of acute stroke treatment between Asians, Blacks and Whites are limited due to a lack of racial diversity in typical hospital catchment areas. Methods: Consecutive patients with ischemic or hemorrhagic stroke (intracerebral [ICH] or subarachnoid hemorrhage [SAH]) admitted to a single, comprehensive stroke center located in a racially diverse, underserved metropolitan area were prospectively enrolled in a registry between 9/2014-2/2017. Stroke risk factors, admission NIHSS, insurance status and acute stroke treatments (including IV tPA and/or mechanical thrombectomy) were compared between Asian, White and Black patients. Results: Of 1045 stroke patients, 170 (16%) were Asian, 226 (22%) were Black and 649 (62%) were White. Asians had significantly higher rates of ICH than Blacks or Whites (17% versus 6% and 8%, respectively, P Conclusions: In a single site study with minimal geographic/environmental heterogeneity, Asians and Blacks had higher rates of hemorrhagic strokes than Whites and higher rates of being underinsured. Rates of IV tPA utilization were lowest among Blacks, though rates of mechanical thrombectomy were similar across races. Lower rates of IV tpa use appear related to factors other than insurance status or treatment bias.

Introduction: Though some randomized trials of mechanical thrombectomy included octo- and nonagenarians, there is little data on outcomes among the oldest of the old. Methods: Consecutive patients with ischemic stroke admitted to a single, comprehensive stroke center were prospectively enrolled in a registry between 9/2014-2/2017. Rates of mechanical thrombectomy were compared over 10-year patient age epochs. Among those who underwent thrombectomy, recanalization rates, and discharge disposition were compared over age epochs after adjusting for admission NIHSS using multivariable logistic regression analysis. Cochrane-Armitage test of trend was used to assess for dose effect of age on discharge disposition. Good discharge disposition was defined as discharge to home, acute rehabilitation or outpatient physical therapy. Results: Of 1245 ischemic stroke patients, 221 (18%) underwent mechanical thrombectomy. Thrombectomy occurred in 13/75 (17%) aged 40-49, 23/176 (13%) aged 50-59, 41/274 (15%) aged 60-69, 53/289 (18%) aged 70-79, 55/287 (19%) aged 80-89, and 30/108 (28%) aged 90-99. There was no significant difference in thrombectomy rates per age epoch after adjusting for NIHSS. TICI2b-3 recanalization rates (85-93% of cases), IV tPA use (25/221, 11%), and withdrawal of life-sustaining therapy (7%) did not differ significantly across age epochs. However, after adjusting for admission NIHSS, the rates of good discharge disposition decreased proportionately, in a dose effect manner with each 10-year increase in age (Cochrane-Armitage 16.06, P Conclusions: Despite similarly excellent recanalization rates among stroke patients aged 80-99 years who underwent mechanical thrombectomy, good discharge disposition was significantly worse in the oldest of the old after adjusting for admission NIHSS. Nonetheless, nearly half of octogenarians and a third of nonagenarians who underwent mechanical thrombectomy were able to go home or to acute rehabilitation.

A large number of patients presenting with acute ischemic stroke have large artery intracranial occlusions, and timely recanalization of these occlusions often leads to improved neurologic outcome. Starting with the widespread use of IV tissue plasminogen activator, a wide variety of pharmacologic and mechanical methods have been introduced to improve vessel recanalization and clinical outcome of patients with acute ischemic stroke, which include endovascular therapies such as intra-arterial thrombolytics and mechanical thrombectomy devices. One of the potential therapies is angioplasty and stenting, and this has been evaluated in multiple case reports and small series published by various centers regarding its use in this setting. In this article, we review the current literature on stenting with and without angioplasty, used alone or as a part of multimodal therapy for recanalization for acute cerebrovascular occlusions.

Objective Multiple intracranial aneurysms are common. While sequential clipping of multiple aneurysms during a single open surgical procedure has been reported, the same is not true for endovascular coiling. We present our experience describing the safe coiling of multiple aneurysms in the same setting. Methods Retrospective review of our coiling log between 2006 and 2009 showed six cases in which multiple aneurysms were coiled in the same session. Results All patients were coiled using the same microcatheter. Distal aneurysms were coiled first. Good occlusion rates were achieved in all cases. There were no thromboembolic events or procedure-related rupture or mortality. Conclusion In addition to safety and efficacy, cost savings are expected when coiling multiple aneurysms in the same procedure.

Objective There are limited data about the rate of recanalization following complete coil occlusion. Long term clinical and angiographic outcome of completely occluded intracranial aneurysms (IAs) by the endovascular approach are presented. Methods Over the course of 4 years, patients with IAs which were completely occluded by coiling at our institution were reviewed. Clinical and angiographic data were analyzed. The patients were clinically assessed using the Glasgow Outcome Scale (GOS). Follow-up angiographic findings were categorized as: stable aneurysm with no recanalization, recanalization with a neck remnant and recanalization with a body remnant. Results 83 aneurysms were identified in 74 patients (15 men and 59 women, average age 52.4 years) with complete occlusion post intervention. Treatment by coiling only was used in 73 aneurysms while stent assisted coiling was used in 10 cases. At the last angiographic follow-up (mean 16.3 months), 20 of the 83 aneurysms demonstrated various degrees of recanalization of which five had neck remnants and 15 had body remnants. The recanalization rate was significantly higher in large aneurysms (57%) compared with small aneurysms (14%). Clinically, 65 of the 74 patients showed good recovery (GOS score 5), eight had moderate disability (GOS score 4) and one was severely disabled (GOS score 3). Conclusion Complete endovascular occlusion of IA is certainly effective in preventing aneurysmal bleeding. However, recanalization rate, despite being lower when compared with subtotal occlusion, remains an issue. Longer follow-up is required.

Background: Despite innovations in endovascular stroke treatment, less than 55% of patients have shown good outcomes in multiple randomized clinical trials. In this study we are validating the Interventional Stroke Assessment Scale for Eligibility in Endovascular Therapy (ISAS-ET). Materials: This is a retrospective analysis of all patients (n= 111) who presented to our hospital with ischemic stroke and received advanced stroke treatment between January 2013 and July 2014. Statistical analysis was performed using GraphPad Prism. The scoring system was developed with a score range (0-8), where a high score predicts a better outcome. Patients received 2,1,0 points for collateral scores of 3-4, 2, 0-1 respectively; patients received 2, 1, 0 points for NIHSS scores of 0-10, 11-20 and over 21 respectively; age Results: Results for 59 patients included in this study are as follows: 61% female, mean age 74.0 ± 19.1, mean NIHSS 17.8 ± 7.2, 49.1% AFib and 10.1% mortality. We found a significant correlation between the ISAS-ET score and outcome (95% CI, 3.36-4.24, P < 0.001), mortality (95% CI, 3.93-4.82, P < 0.001) as well as good disposition (95% CI, 3.68-4.56, P < 0.001). Of this group, 94% of the patients with an ISAS-ET score of 1, 2 or 3 had a poor outcome regardless of intervention. Conversely, 86% of the patients with a score of 7 or more had a good outcome. Conclusion: The ISAS-ET scale appears to be appropriate in this single center study at predicting outcome using parameters prior to intervention. This data may help determine the urgency of transfer for intervention in hospitals without endovascular capabilities while helping determine which patients will benefit significantly from intervention. We plan to validate these results in a prospective study.

Background and Purpose: The National Institute of Health (NIH) developed a standardized scale to evaluate the severity of a stroke at presentation. Predicting patient outcome after a vascular event can be very challenging. The objective of this analysis was to study the effect of the motor component of the NIH Stroke Scale (NIHSS) on a patient’s functional outcome at discharge looking at a multicenter group to further validate our observation. Methods: This is a retrospective analysis of all patients (n= 161) that presented to the hospitals with ischemic stroke and received mechanical thrombectomy between January 2009 and July 2014 and had all the components of NIHSS baseline documented at presentation. Statistical analysis was performed using GraphPad Prism to independently evaluate the relationship between the NIHSS components and patient functional outcome at discharge using modified rankin scale (mRS). mRS of 2 or less represented a good functional outcome. All variables were included in the analysis. Results: 112 patients that had all variables and their NIHSS breakdown components documented were included. Group analysis including gender, mean age, mean NIHSS, Afib%, DM%, Prior Stroke % and mortality at discharge were as follows: Female 52.7%, 72.1±16.3, 15.2±7.2, 34.8%, 27.7%, 25.9% and 12.5%. All Motor components of NIHSS in order left arm, left leg, right arm, right leg had a significant correlation with poor patient outcome at discharge (95%CI -3.932- -0.9607, P Conclusion: Admission motor grade may serve as a good predictor of disability and mortality in patients undergoing mechanical thrombectomy with acute ischemic stroke. Further prospective study to validate such an observation is warranted.

Background: Endovascular procedures are associated with injuries to the vasculature. Interventionists have adopted the use of intravenous anti-platelet agents. Eptifibatide drip has been utilized in advanced stroke treatment to increase recanalization in ischemic strokes. This study compares the outcome and mortality between those individuals that received Eptifibatide drip and those who did not. Materials: This is a retrospective analysis of all patients (n= 161) who presented to the hospitals with ischemic stroke and considered for advanced stroke therapy between January 2009 and July 2014. Statistical analysis was performed using GraphPad Prism. We divided the groups into two: (A) Eptifibatide drip (B) No Eptifibatide drip. We compared the effect of using Eptifibatide drip on the functional outcome using modified Rankin Scale (mRS). mRS score of 2 or less defines a good functional outcome and an mRS of 6 defines mortality. All variables were included in the analysis. Results: 161 patients included in this study had all the variables and received Endovascular treatment. Group analysis including n, gender, mean age, mean NIHSS, Afib%, DM% and Prior Stroke % was as follows: A) 66, 47%, 71.6±16.7, 16.0±7.1, 28.3%, 25% and 31.7% B) 95, 62.5% female, 74.5±16.3, 16.5±7.7, 44.2%, 30.5% and 23.2%. We found that patients who underwent endovascular procedures in group A experienced a better outcome and lower mortality as compared to those patients in group B (95% CI, 0.1761-0.3953, P Conclusion: The use of Eptifibatide drip during endovascular procedures may result in a better functional outcome and lower mortality after the procedures as compared to other devices. We plan to further investigate the use of Eptifibatide drip in prospective study.

Background: The importance of early institution of “Do Not Resuscitate” (DNR) orders in determining outcomes from intracerebral hemorrhage is established. In the setting of acute ischemic stroke, African Americans tend to utilize critical care interventions more and palliative care options less than Caucasians. Recent epidemiological studies in acute ischemic stroke have shown a somewhat better survival for African Americans compared with Caucasians. Our hypothesis was that racial differences in early institution of DNR orders would influence mortality in acute ischemic stroke. Methods: a retrospective chart review was conducted on consecutive admissions for acute ischemic stroke across 10 hospitals in Michigan for the year 2006. Subjects with self reported race as African American or Caucasian were selected. Demographics, stroke risk factors, pre morbid status, DNR by day 2 of admission, stroke outcome and discharge destination were abstracted. Results: The study included 574 subjects (144 African American, 25.1%; 430 Caucasian, 74.9%). In-hospital mortality was significantly higher among Caucasians (8.6% vs. 1.4% amongst African Americans, p=0.003). More Caucasians had institution of DNR by day 2 than African Americans (22.5% vs. 4.3%, ptable ). Caucasians with coronary disease, atrial fibrillation, severe strokes and unable to walk prior to the stroke tend to be made DNR by day 2 more frequently. Only 27.1% of Caucasians with early DNR orders died in the hospital, whereas 20.8% were eventually discharged home. Conclusions: Early DNR orders result in a racial disparity in mortality from acute ischemic stroke. A substantial proportion of patients with early DNR orders eventually go home. Postponing the use of DNR orders may allow aggressive critical care interventions that may potentially mitigate the racial differences in mortality.

Objective To report our experience with stent supported intracranial recanalization for acute ischemic stroke beyond 8 h of symptoms onset. Background Acute ischemic stroke (AIS) therapy is often limited to an 8 h window using mechanical means. However, recent reports have shown delayed recanalization beyond 8 h might be a viable option in a subset of patients. Methods A retrospective review was performed of our AIS database for patients who underwent stent supported intracranial recanalization beyond 8 h of symptom onset. Clinical and angiographic data were reviewed. Outcome was measured using modified Rankin Scale (mRS) scores at 30 and 90 days. Results 12 patients (11 men and one woman) underwent delayed stenting for AIS. Mean age was 49 years (range 37–73) and mean National Institutes of Health Stroke Scale was 17 (range 8–29, median 15). Mean time from stroke onset to intervention was 66.1 h (range 10–168 h, median 46 h). 10 patients presented with a Thrombolysis in Myocardial Infarction (TIMI) score of 0 and the remaining two had a TIMI of 1. Recanalized vessels included: left middle cerebral artery (n=6), basilar trunk (n=2), vertebrobasilar junction (n=3) and internal carotid artery (ICA)-T (n=1). Four patients had prior attempts of embolectomy/thrombolysis using mechanical and chemical means. Stents used included: six balloon mounted stents, five Wingspan and one Enterprise self-expanding intracranial stent. Recanalization, defined as a TIMI score of 2 or more, was achieved in 11 patients. Two patients (17%) had intracranial hemorrhage. Thirty day mRS of ≤3 was achieved in six patients (50%). Seven patients (58%) had a 90 day mRS of ≤2. Conclusion Stent supported intracranial recanalization is a safe and feasible approach in a selective group of patients presenting with acute ischemic stroke beyond 8 h of symptom onset.

Background and objective The outcome of failed recanalization in patients with acutely symptomatic intracranial vertebrobasilar (VB) artery occlusive disease is poor. This paper reports the recanalization rate and safety of VB artery stenting in acutely symptomatic patients presenting >8 h after onset of symptoms. Methods A retrospective review of a prospectively maintained database of stent-supported endovascular treatment of intracranial circulation was carried out to identify patients with VB artery occlusive disease who were acutely revascularized >8 h after symptom onset. Results Of 12 patients (mean age 61 years), nine had acute stroke and three had recurrent transient ischemic attacks. The median time to intervention was 59 h (range 8–80). The median National Institute of Health Stroke Scale score was 11.5 (range 1–40). Angiography showed thrombolysis in myocardial infarction (TIMI) 0 flow in six patients and TIMI 1 flow in the other six. Stents were placed in the basilar artery in six and at the VB junction in the other six. Mechanical and/or intra-arterial thrombolysis was used in three patients before stenting. Nine patients had self-expanding stents and three had balloon-expandable stents. The recanalization rate was 100%. Procedure-related and 3-month mortality was zero. Two patients had asymptomatic intracranial hemorrhage. At 3-month follow-up a favorable outcome with a modified Rankin score ≤2 was achieved in eight. A follow-up angiogram in eight patients showed mild re-stenosis in three. Conclusion Stent-supported VB artery revascularization can be a viable option with an acceptable safety profile in acute VB occlusion or unstable intracranial atherosclerotic arterial disease (ICAD) in carefully selected patients.

Objective: To report an outcome of post cardiac catheterization stroke patients treated with endovascular intervention. Background Cardiac catheterization related stroke has an incidence of 0.03% to 0.3% for diagnostic procedures and 0.3–0.4% for percutaneous coronary intervention (PCI). Endovascular interventions have added a new option for treatment in patients with embolic occlusion of large vessel occlusion. Design/Methods: Following retrospective data was collected from 2007 to September 2011 for post cardiac catheterization stroke and endovascular intervention : demographics, risk factors, National Institute of Health Stroke Scale- NIHSS, arterial involvement, type of intervention, outcome. Results: Nine patients underwent cerebral angiogram for post cardiac catheterization stroke. Five patients (mean age- 76.3 years, 1 male and 4 female, all black) had large arterial occlusion, 2 middle cerebral, 1 carotid bifurcation, 1 anterior cerebral, 1 basilar artery. All patients had history of hypertension, hyperlipidemia and coronary atherosclerosis. Two had severe heart failure, one had left ventricular thrombus and one had descending aorta thrombus. None of them had atrial fibrillation. Median NIHSS was 17.5. All interventions were performed within 8 hours of symptoms. Three received intravenous thrombolysis. Pre TIMI score was 0 in 4 and 1 in 1 patient. Intra arterial thrombolysis was used in 3 while mechanical thrombectomy (MERCI or Penumbra) in 4. Post procedure, 3 patients had TIMI 3 recanalization and 2 had TIMI 2. None of them had hemorrhage. Two patients (Basilar, carotid bifurcation occlusion) died during hospitalization due to large stroke in spite of recanalization. At discharge, modified Rankin scale was 2 in 2 patients and 3 in 1. Conclusions: Some patients with post-cath large vessel occlusion can be salvaged with a reasonable functional outcome. Mortality/bad outcome rate remains high with endovascular intervention in spite of good recanalization rate. Further data is needed to evaluate the factors predicting the outcome in this group of patients. Disclosure: Dr. Kansara has nothing to disclose. Dr. Damani has nothing to disclose. Dr. Tiwari has nothing to disclose. Dr. Narayanan has nothing to disclose. Dr. Chaturvedi has received personal compensation for activities with Genentech, Inc., and Abbott Vascular. Dr. Xavier has received personal compensation for activities with Concentric as a consultant.