Abstracts of the 52nd Annual Conference of the Italian Society of Neurology OUTCOME AND MORTALITY IN PATIENTS WITH HEART FAILURE AND ISCHEMIC STROKE TREATED WITH MECHANICAL THROMBECTOMY: AN ANALYSIS OF THE ITALIAN REGISTRY OF ENDOVASCULAR TREATMENT IN ACUTE STROKE (IRETAS)

Introduction: Heart Failure (HF) is the second most important cardiac risk factor for stroke after atrial fibrillation (AF). Few data are available on mechanical thrombectomy (MT) in acute ischemic stroke (AIS) patients with HF. Patients and methods: the source of data is the multicenter Italian Registry of Endovascular Treatment in Acute Stroke (IRETAS). All AIS patients ≥ 18 years receveing MT were categorised in two groups: HF and no-HF. Baseline clinical and neuroradiological findings were analysed. Results: Of 8924 patients, 642 (7.2%) had HF. HF patients had higher prevalence of cardiovascular risk factors. Rate of complete recanalization (TICI 2b-3) (p=0481) and symptomatic intracerebral hemorrhage at 24-hours (p=0.520) were comparable between the two groups. At 3 months, 36.4% of HF patients and 48.2% of no-HF patients (p <0.001) had mRS 0-2 and mortality was respectively 30.7% and 18.5%, (p <0.001). Quantitative Left Ventricular Ejection Fraction (LVEF) data were available for 364 (56.69%) of 642 HF patients. No statistically significant differences were found among LVEF groups in terms of 90-day good outcome or mortality. General anaesthesia (GA) was associated with a good outcome(mRS 0-2) in 32.2%, versus 41.0% of no-GA group (p=0.034). In multivariate logistic regression HF was independently associated with mortality at 3 months (OR 1.53, 1.24-1.88 95% CI, p<0.001). In multivariate ordinal regression, HF patients had a probability of transitioning to a higher mRS level of 1.23 (1.05-1.44 95% CI, p= 0.012). The propensity score analysis of two groups yielded the same results. Conclusion MT is safe and effective in AIS patients with HF. As compared to no-HF patients, AIS patients with HF suffered from higher 3-month mortality and unfavourable outcome, due to their intrinsic frailty and not as a consequence of the acute treatments that they received. Hence, MT is a valid option for AIS patients with HF, with a special caution required as to anesthesiological approach and blood pressure control during treatment.