Abstracts

Rationale:
Early post stroke seizures(EPSS) may be associated with increased morbidity and mortality in the stroke patient. We wanted to evaluate the incidence, predictors, and functional outcomes of EPSS in patients presenting with an acute ischemic stroke(AIS) with large vessel occlusion (LVO) 6-24 hours from last known well (LKW)who underwent recanalization with endovascular mechanical thrombectomy(MT).
Method:
We conducted a single center retrospective analysis of all patients presenting with AIS with LVO between May 2016 and May 2019. Patients presenting in the extended window time frame, 6 to 24 hours from LKW who underwent treatment with MT were included. Patients who suffered EPSS, defined by clinical presentation or electrographic evidence within 1 week of presentation were identified. All patients were further evaluated for disability at 90 days using the modified Rankin Scale (mRS). An mRS score of <2 was defined as a good functional outcome. Additional factors were also evaluated to assess for possible confounding variables, including; age, sex, comorbidities, presenting National Institute of Health Stroke Scale (NIHSS), LKW to groin puncture time and Thrombolysis in Cerebral Infarction (TICI) scores. Patient information was collected from the Houston Methodist Hospital Outcomes Based Prospective Endpoints in Stroke (HOPES) registry.
Results:
A total of 98 patients were evaluated, from which 4 were found to have EPSS following extended window (6-24 hours from LKW) MT.  All patients in the EPSS group had multiple comorbid conditions like hypertension, hyperlipidemia, type II diabetes mellitus, atrial fibrillation, coronary artery disease and prior stroke. We did not find any differences in gender, NIHSS, TICI scores or presenting NIHSS between the two cohorts (p >0.05). In our cohort, seizures were either focal impaired awareness (3/ 4) or focal to bilateral tonic clonic (1/ 4). None of the patients presented with difficult to control seizures or status epilepticus. Multivariate ordinal logistic model showed that patients with EPSS were approximately eight times more likely to have poor functional outcomes at 90 days, with progressively severe disability of these patients when compared to patients without seizures (OR =7.7, 95% CI. [1.1 – 54.9], p=0.04). 
Conclusion:
This retrospective study looks at EPSS specifically following extended window(6-24 hr from LKW)MT for AIS with LVO. We found that 4.08 % of patients had EPSS following extended window MT in our cohort. Based on our analytical cohort of Extended Window LVO patients, we found no identifiable risk factors that would increase the incidence of EPSS. Our model also showed that EPSS significantly increases the risk of poor functional outcomes at 90 days. Given the low number of EPSS in our cohort, larger multicenter studies would be beneficial to evaluate the incidence, predictors, and functional outcomes of EPSS in Extended Window LVO patients
Funding:
:None