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Introduction: Mechanical thrombectomy (MT) for large vessels occlusion of anterior circulation acute ischemic stroke (AIS) improves functional outcome at 3-month. However, elderly patients (≥80 years old) are a growing and fragile population for whom data are scarce. Hypothesis: To determine the factors associated with a favorable functional outcome after endovascular treatment for anterior circulation AIS in elderly patients. Methods: All patients aged≥ 80 years old with anterior circulation AIS and a primary functional independence (mRS Results: A total of 82 patients were treated for anterior circulation AIS with a recanalization rate of 87%. The NIHSS score was improved from 16.7 ± 6 [range: 3-27], to 12.2 ± 8.2 [range: 0-32] at 24h, (p=0.0001) and 9.3 ± 7.77 [range: 0-32] at discharge (p=6 x 10-7). We found a SIH rate of 1% while 40% of patients had intracranial hemorrhage, mortality was 27%, and at 3 months 29% of patients were functionally independent (mRS ≤ 2) and 16% had moderate disability (mRS=3). DWI-ASPECTS (p=0.007), low initial NIHSS (p=0.013), age (p=0.02) and IV thrombolysis (p=0.03), were associated with a favorable functional outcome. Use of general anesthesia (p=0.09), diabetes (p=0.05) and hyperglycemia (p=0.05) were associated with a poorer outcome at a lesser degree. Conclusions: MT of anterior circulation AIS in elderly patients is safe and effective.

Introduction: Ischemic strokes with tandem occlusions are associated with a poor prognosis. Recent studies demonstrating the effectiveness of endovascular treatment for large vessel occlusions have shown less impressive results in patients with tandem occlusions than in those with isolated intracranial occlusions. Besides, the indications and effects of ICA stenting remain unclear. Hypothesis: To determine the factors associated with favorable outcome at 3-month in this subtype of AIS. Methods: From a prospectively gathered registry, we analyzed the data of 70 consecutive patients who underwent mechanical endovascular treatment for acute stroke with tandem occlusions from November 2011 to August 2014. Clinical (including demographics, NIHSS, and stroke etiology), imaging (including DWI-ASPECTS), and endovascular treatment data were assessed and reviewed in consensus by two observers. Good clinical outcome was defined as a modified Rankin Scale (mRS) of ≤2 at 3-month follow-up. The mRS at 3 months follow-up was available in 67 patients. Results: At 3-month follow-up, 33 of 67 (49.3%) patients had a good clinical outcome and 34 (50.8%) had a poor clinical outcome, including 9 deaths (13.4%). Lower NIHSS (initial, at day 1, and at discharge) and successful recanalization (TICI 2b-3) were associated with a good clinical outcome (P Conclusions: Despite the recent randomized control trials demonstrating the effectiveness of thrombectomy, there is still a research gap about tandem occlusions. This subtype of stroke, which usually responds poorly to intravenous thrombolysis, is also difficult to treat by endovascular means.

Introduction: The ADAPT (a direct aspiration first pass technique for acute stroke thrombectomy), using large bore aspiration catheters, has been reported to be a fast, safe, simple and effective method of mechanical thrombectomy (MT) that has facilitated the treatment of acute ischemic strokes. Hypothesis: An attempt to determinate the favorable factors leading to a satisfactory reperfusion (TICI 2b/3) with ADAPT in anterior circulation ischemic stroke patients with confirmed large vessel occlusions. Methods: Based on our prospectively gathered database we extracted patients who were admitted for MT in anterior circulation ischemic strokes since August 2013 and for whom ADAPT was used as the first MT option. Patient demographics, initial NIHSS, localization and lateralization of the occlusion, DWI-ASPECTS, IV thrombolysis prior to MT, time from stroke onset to femoral puncture, final TICI score and 3-month mRS were analyzed. Results: ADAPT was effective in achieving a TICI2b/3 in 54.7% of 309 patients. Two factors influenced positively the success of reperfusion with ADAPT as a stand alone procedure: an isolated MCA occlusion (p Conclusions: ADAPT is very effective in case of isolated MCA occlusion ischemic strokes. The relevance of ADAPT over stent retrievers in other anterior circulation localizations (carotid siphon and tandem occlusions) has to be evaluated with a randomized study.

Purpose: The angiography-based capillary index Score (CIS) has recently emerged as a potential tool for assessing viable tissue. Our study aimed at correlating the CIS with patient outcomes. Materials and Methods: Based on our prospective gathered (December 2011 to April 2014) database, we analyzed the charts of patients who presented with anterior circulation acute ischemic stroke and elected for mechanical thrombectomy (MT). Patient age, NIHSS at admission, DWI-ASPECTS, pre-MT TICI score, CIS, post-MT TICI score, time from onset to reperfusion, 3-month mRS were analyzed. Patients were dichotomized into two groups: favorable (mRS≤2) and poor (mRS≥3) outcomes at 3-month follow-up. Univariate statistical analysis was carried out to determine which factors were the most determinant for patient outcome using the 3-month outcome. Then logistic regression analysis was performed to refine the results. Results: A total of 287 consecutive patients were elected for anterior circulation MT, 160 patients had a CIS and 138 of them had a complete follow-up including a 3-month mRS. They were (72 males, 67 females; mean age: 64). Sixty-nine out of the 138 patients (50.0 %) had a favorable outcome at 3-month. The 3-month mortality was 18.1%. Good reperfusion (TICI ≥ 2b) was obtained in 77.1% of the patients. The mean time from stroke onset to reperfusion was 5.9 hours. Univariate analysis showed that the statistically significant factors for a favorable 3-month outcome were the CIS and the NIHSS at admission (p Conclusions: High initial CIS are associated with better outcomes in acute ischemic stroke patients who undergo MT arguing that, along with the infarct volume, the assessment of arterial collateral supply is a striking determinant of patient outcome.