Abstract 193: Stroke Angio: The Role of Emergent Catheter Angiography in Disabling Cortical Symptoms and Negative CTA, Experience in 22 Cases

Introduction Current stroke protocol requires CT angiography (CTA) to evaluate the necessity of mechanical intervention versus best medical therapy alone. However, we hypothesize based on published literature, CTA can miss medium or distal vessel occlusions that may be amenable to safe mechanical interventions. These medium and distal vessel occlusions causing disabling stroke symptoms may benefit from mechanical thrombectomy. We describe our experience with emergent catheter angiography, termed “Stroke Angio,” in patients who present with disabling cortical stroke symptoms concerning for medium or distal vessel occlusion with none identified on CTA. Methods A prospectively‐maintained, IRB‐approved database was retrospectively reviewed to identify patients who (1) presented with disabling cortical symptoms, (2) had negative CTA findings, and (3) subsequently underwent a Stroke Angio procedure. Results A total of 22 patients were identified who were taken for a Stroke Angio with a negative CTA. Average age was 75.8 ± 2.1 with an average NIH Stroke Scale score (NIHSS) of 11.2 ± 1.8. Of the total number of cases, 9 (41%) underwent mechanical thrombectomy. Occlusions were located in the distal M1 branch (2 cases, 22%), M2 (3 cases, 33%), and M3 (4 cases, 44%). Six patients (66%) achieved TICI 3, 2 (22%) patients obtained TICI 2C, and 1 patient with TICI 1 (11%). Stroke Angio findings for the rest of the cohort were negative (8 cases, 61.5%), stenosis (3 cases, 23.1%), and sub‐occlusive thrombus (2 cases, 15.4%). Conclusion Our findings demonstrate that nearly half of patients with disabling strokes and a negative CTA were found to have treatable occlusions, with most achieving successful reperfusion following thrombectomy. Stroke Angio not only enabled timely interventions but also provided diagnostic clarity in patients who did not qualify for thrombectomy. These results highlight the limitations of CTA in medium and distal vessel occlusions and support incorporating emergent catheter angiography into stroke triage protocols for patients with disabling cortical symptoms. image