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Abstract 21: Should Aphasic Ischemic Stroke Patients Undergo Pre-procedural Intubation prior to Endovascular Treatment?


 Background:
 Current practice in the endovascular treatment of acute ischemic stroke includes pre-procedural intubation of aphasic stroke patients to ensure immobility during the procedure. Multiple series have shown that pre-procedural intubation for endovascular procedures leads to a higher rate of poor outcomes mandating a critical review of such ancillary interventions.
 
 
 Objective:
 To compare outcomes in acute ischemic stroke patients with aphasia of various severities undergoing endovascular treatment with or without pre-procedural intubation.
 
 
 Methods:
 All endovascularly treated acute ischemic stroke patients were identified through a prospective database maintained from two comprehensive stroke centers over a 6 year period. Patients’ risk factors, type of aphasia, and pre-procedural intubation status were obtained. The rate of unexpected intubation in patients without pre-procedural intubation was ascertained. The rates of poor outcome at discharge (modified Rankin score [mRS] of≥3) and intracerebral hemorrhage (ICH) were compared between those who did or did not undergo pre-procedural intubation after adjustment for age, gender, admission NIHSS score, diabetes mellitus, and cigarette smoking.
 
 
 Results:
 A total of 120 patients with aphasia were identified; with 60 (50%) patients intubated prior to the revascularization procedure. Among the remaining patients who were not intubated prior to the procedure 21 (35%), 31 (52%), and 8 (13%) had global, expressive, and receptive aphasia, respectively. We identified 6 (10%) patients who required intra-procedural intubation. The odds of any ICH (odds ratio [OR] 6.3, 95% confidence interval [CI] 1.6-24.0) and in-hospital mortality [OR 9.3, 95% CI 2.7-31.0] were significantly higher among those who underwent pre-procedural intubation after adjusting for potential confounders. The rates of favorable outcomes at discharge were significantly lower among patients who underwent pre-procedural intubation [OR 0.1, 95% CI 0.04-0.2].
 
 
 Conclusions:
 Endovascular revascularization among aphasic, acute ischemic stroke patients should be attempted without intubation, in an effort to reduce intra-procedural complications, such as ICH and death.
