P-021 Tiger study: shorter arterial puncture to revascularization times and first pass effect improves angiographic and clinical outcomes

P-021 Table 1 Group mTICI 2b-3 After first Tiger pass D NIHSS @ 24 hrs mRS 0-2 @ 90 days mRS 0-1@ 90 days sICH @ 24 hours Mortality@ 90 days ENT Arterial puncture to Revascularization £25 min, 52% (median 17) 87.5% -10.3 73.5% 66.2% 0 11.1% 1.4% >25 min, 48% (median 44) 34.8% -8.3 51.5% 33.3% 2.9% 19.7% 4.5% P value 0.00001 0.14 0.009 0.0001 0.13 0.16 0.28 LKW to Arterial puncture £178 min, 50% (median 125) 56.8% -9.9 57.1% 47.1% 1.3% 14.9% 1.4% >178min, 50% (median 291.5) 63.0% -7.7 63.0% 47.9% 2.7% 18.9% 4.1% P value 0.44 0.11 0.47 0.92 0.55 0.51 0.31 LKW to Revascularization £220 min, 50% (median 151.5) 64.3% -10.5 62.1% 50.0% 0 14.5% 1.4% >220 min, 50% (median 320) 60.3% -7.7 63.2% 50.0% 2.9% 15.9% 4.3% P value 0.63 0.09 0.90 1.00 0.15 0.81 0.31 Abstracts A36 J NeuroIntervent Surg 2021;13(Suppl 1):A1–A156 on S etem er 3, 2023 by gest. P rocted by coright. http/jnis.bm jcom / J N eurotervent S urg: frst pulished as 10.1136intsurg-2021-S N IS 57 on 26 July 221. D ow nladed fom faster (£220 min) compared with slower (>220 min) time from LKW to revascularization were not associated with statistically significant differences in outcome. There were no statistically differences in safety outcomes in faster compared to slower times. Conclusions Among patients with acute ischemic stroke due to large vessel occlusion, faster time from arterial puncture to revascularization is strongly associated with improved angiographic and 3 month clinical outcomes. These data emphasize the importance of rapid and efficient catheter navigation, device deployment, and clot retrieval for best patient outcomes. Disclosures A. Jadhav: None. R. Gupta: None. E. Levy: None. O. Zaidat: None. D. Yavagal: None. J. Saver: None. P-022 ENDOVASCULAR TREATMENT OF WIDE-NECK BIFURCATION ANEURYSMS: A SINGLE-CENTER EXPERIENCE AND PARADIGM SHIFT A Copelan*, J Delgado Almandoz, Y Kayan, J Scholz. Neurointerventional Radiology, Abbott Northwestern Hospital, Minneapolis, MN 10.1136/neurintsurg-2021-SNIS.58 Purpose To present our single center experience utilizing balloon-assisted coiling (BAC), stent-assisted coiling (SAC) and Woven Endo-Bridge (WEB) embolization for the treatment of both ruptured and unruptured wide-necked bifurcation aneurysms (WNBAs) with a focus on the safety and efficacy profiles of each technique. Methods We retrospectively reviewed all WNBAs treated at our institution with BAC, SAC, and WEB embolization between January 2012 and August 2020. Required aneurysm characteristics were in line with the pivotal WEB Intrasaccular Therapy (WEB-IT) study and included: ruptured or unruptured status; size of dome between 3mm and 10mm; wide-neck defined by neck size 4 mm or dome-to-neck ratio <2; and location limited to the basilar tip (BTA), internal carotid artery terminus (ICA-T), anterior communicating artery complex (ACOM), and middle cerebral artery (MCA) bifurcation. We collected patient demographic variables, aneurysm characteristics, intraprocedural technical difficulties (ITDs), perioperative complications, and aneurysm occlusion rates. Group differences were assessed and logistic regression models were utilized to analyze more complex relationships. Results Three hundred one aneurysms met inclusion criteria and included 141 in the BAC group, 81 in the SAC group, and 79 in the WEB group. Nearly 27% of aneurysms were ruptured and the mean maximum aneurysm size was 6.3mm (± 1.9mm), mean neck 3.4mm (± 1.3mm), and dome-to-neck ratio 1.6 (± 0.5). There was a 6% incidence of ITDs in the WEB cohort, significantly less than the 17% incidence in SAC (p=0.03), and resulting new persistent neurological deficits occurred in 5% of SACs and 4% of BACs, higher than the WEB cohort in which there were none, and this approached statistical significance (p=0.09). Adequate aneurysm occlusion rates were achieved at significantly higher rates with SAC (90%) and WEB embolization (85%) compared to BAC (75%) (p=0.014). Conclusion The WEB device is a valuable addition to the neurointerventionalist’s armamentarium, permitting adequate occlusion of challenging WNBAs often not suitable for BAC and with an improved safety profile relative to SAC. Abstract P-022 Table 2 Angiographic occlusion and retreatmentP-022 Table 2 Angiographic occlusion and retreatment BAC (n=120) SAC (n=73) WEB (n=71) TOTAL P-values Complete occlusion 47 (39.2%) 64 (87.7%) 40 (56.3%) 151