MR Screening for Acute LVO Stroke Intervention, a Patient Specific Paradigm Brian Cristiano, MD; M. Pond, MD; R. Nowrangi, MD MPH; S. Basu, MD; U. Oyoyo, MPH; J.P Jacobson, MD MPH

58 M NIHSS 19 LSW 16:30 CTA 17:38 (1:08)

58 M NIHSS 21 LSW 18:30 received IV tPA at 20:19 (1:39) CTA at 22:53 (4:23)

61 M NIHSS 11 LSW 4:00 CTA at 9:47 (5:47)

57 M NIHSS 11 LSW day prior at 22:00 CTA at 14:47 (16:47))

Baseline TICI 0 TICI 2b at 16:42 (18:42) discharged home on PPD 2 mRS 2

Time ≠ Brain

Hypothesis and Aims LVO patients with small DWI core volume will show similar good outcomes after thrombectomy regardless of time from LSW A patient specific, MR driven, patient selection strategy will outperform a patient selection strategy based on arbitrary time criteria

Methods Logistic regression analysis based on a retrospective cohort anslysis of 56 LVO patients treated with thrombectomy at LLUMC between 11/1/2012 and 5/15/2015 with final infarct volume < 50 mL the primary outcome variable Cost utility modeling based on the same 56 patient LVO treatment cohort, a separate retrospective cohort analysis of 25 LVO candidates screened at LLUMC between 2/1/2015 and 5/30/2015, and published outcomes and cost utility data in USD with a willingness to pay threshold of 50,000 USD / QALY

Summery Presentation core volume is the most important predictor of outcome after thrombectomy Time from LSW does NOT predict infarct extent at the time of presentation or final infarct volume after intervention LVO patients with small presentation core volume and significant PWI mismatch probably benefit from thrombectomy regardless of LSW time A patient specific MR driven selection strategy will likely outperform an arbitrary time driven selection strategy

Door  MRI  Lab

Acknowledgments Loma Linda University Departments of Radiology, Neuroradiology and Stroke Neurology Special thanks to Vincent Truong, MD, Georgy Liljedahl, RN and Sheri Harder, MD IRB 5140107 Quantitative Brain MRI Predictors and Markers of Neurological Outcome Please Direct Correspondence to J. Paul Jacobson, MD MPH Loma Linda University Medical Center 11234 Anderson Street, Room B623 Loma Linda, CA 92354 pjacobson@llu.edu