Disclosures A. Honarmand: None. M. Hurley: None. F. Syed: None. S. Ansari: None. A. Shaibani: None. E-005 PRIMARY ACUTE STROKE THROMBECTOMY WITHIN 3 HOURS FROM LARGE ARTERY OCCLUSION (PAST3-LAO) – A PILOT STUDY 1 Y Lodi, 2 Y Lodi*, 2 V Reddy, 3 A Devasenapathy, 4 G Petro, 5 A Hourani, 6 C Chou . 1 Neurology, Neurosurgery and Radiology, Upstate Medical University, Syracuse/UHS-Wilson Regional Medical Center, Binghamton, NY; 2 Neurology, Neurosurgery and Radiology, Upstate Medical University, Binghamton, NY; 3 Neurology, Neurosurgery and Radiology, UHS-Wilson Regional Medical Center/Upstate Medical University-Binghamton Clinical Campus, Binghamton, NY; 4 Radiology, UHS-Wilson Regional Medical Center, Johnson City, NY; 5 Thomas Watson School of Engineering, Binghamton University, Binghamton, NY; 6 Department of Systems Science and Industrial Engineering, Thomas J. Waston School of Engineering and Applied Science Binghamton University – SUNY, Binghamton, NY 10.1136/neurintsurg-2015-011917.80 Background In acute ischemic stroke (AIS), 1.9 million cells die each minute. Therefore, an early effective recanalization is neces- sary to salvage the penumbra and to achieve a good outcome. AIS due to a large artery occlusion (LAO) with high NIHSS (>10), especially in internal carotid artery terminus (ICA-T) are resistant to IV thrombolysis and endovascular thrombectomy is associated with better recanalization rates. Recent randomized controlled trial demonstrated better recanalization rate and out- come in endovascular therapy compared to IV thrombolysis in AIS with LAO. Despite the benefit with endovascular therapy, 68% of patients were either disable or dead. Thrombectomy in AIS with LAO within 3 h (IV t-PA window) is performed as sec- ondary therapy after IV thrombolysis, which is associated with delay in enrollment and recanalization. The delay in recanaliza- tion may be responsible for the disproportion between accept- able recanalization and good functional outcomes. The delay in recanalization may be responsible for not achieving a good func- tional of those who had acceptable recanalization. Objectives To evaluate the feasibility, safety and recanalization rate of primary acute thrombectomy within 3 h in AIS with NIHSS ‡10 from LAO. Additionally, we like to identify the func- tional outcome. Methods Based on institutionally approved protocol patients with LAO (ICA-T, MCA, vertebral-basilar artery) with LCB within 3 h were offered primary thrombectomy as an alternative to IV rtPA. They were entered into a stroke database. Patients who underwent PAST3 from LAO from 2012 to 2014 were ret- rospectively analyzed using SAS software. Outcomes were meas- ured using modified Rankin Scale (mRS). Results 18 patients with LAO; mean age 628.3 ± 15.32 years and mean NIHSS 16 ± 4; chose primary thrombectomy after informed consent. Thrombectomy was performed using stent- retriever device in addition to intra-arterial rtPA (2–10 mg). Mean number of passes was 1.6 ±. 0.9. Near complete (TICI2b) recanalization was observed in 5.56%% and complete (TICI3) in 94.44% of patients. Mean time to recanalization from symptoms onset was 188.5 ± 82.7 min. Immediate post-thrombectomy, 24 h and 30 day NIHSS score was 4.44 ± 3.75, 1.9 ± 3.2 and 0.28 ± 96 respectively. There was no procedure related compli- cation. Asymptomatic perfusion related hemorrhage developed in 6 patients. 30 days mRS distributions was as followings: mRS0 38.89%, mRS1 44.44 % and mRS2 16.67%. 90 days out- comes were observed in followings: mRS0 50%, mRS1 44.44%, mRS2 5.56%). Conclusion: Our pilot study demonstrates that primary thrombectomy using SRT in AIS due to a LAO is not only safe and feasible, but associated with acceptable recanaliza- tion resulting in exceptional good functional outcome. Larger randomized controlled studies are needed. Disclosures Y. Lodi: None. Y. Lodi: None. V. Reddy: None. A. Devasenapathy: None. G. Petro: None. A. Hourani: None. C. Chou: None. E-006 THE TIME OF RECANALIZATION SINCE SYMPTOMS IS A PREDICTOR OF OUTCOME IN PATIENTS WHO UNDERWENT STENT RETRIEVER THROMBECTOMY FOR ACUTE ISCHEMIC STROKE FROM MIDDLE CEREBRAL ARTERY OCCLUSION 1 Y Lodi*, 2 V Reddy, 2 A Devasenapathy, 3 A Hourani, 3 C Chou. 1 Neurology, Neurosurgery and Radiology, Upstate Medical University, Syracuse/UHS-Wilson Regional Medical Center, Binghamton, NY; 2 Neurology, Neurosurgery and Radiology, UHS-Wilson Regional Medical Center/Upstate Medical University-Binghamton Clinical Campus, Johnson City, NY; 3 Department of Systems Science and Industrial Engineering, Thomas J. Waston School of Engineering and Applied Science Binghamton University – SUNY, Binghamton, NY 10.1136/neurintsurg-2015-011917.81 Background The outcome of patients in acute ischemic stroke (AIS) due to a large artery occlusion (LAO) with high NIHSS (10 or higher), who recanalize less than 3 h of symptoms versus those more than 3 h, has not been clearly investigated. There- fore, these patients may encounter delay in enrollment for appropriate therapy such as stent retriever thrombectomy (SRT) resulting in delay in recanalization, which may not guarantee a good outcome. Despite the positive result, MR CLEAN trial demonstrated good functional outcome only 32% of patients in endovascular arm which may be responsible for delay in the enrollment (average 4 h). Objective The objective of our study is to determine the predic- tor of functional outcome in AIS patients with high NIHSS who underwent SRT from middle cerebral artery (MCA) occlusion. Additionally, we compared the radiographic and functional out- come of those who recanalized less than hours versus whose more than 3 h. Method We analyzed data from consecutive AIS patients of MCA occlusion with NIHSS ‡8 who underwent SRT were enrolled from 2012 to 2014. Demographics characteristics, time of stroke onset, time of intervention, time of recanalization from groin puncture, time of recanalization since symptoms, baseline NIHSS, 24 h and 30 days after the procedure, and 30 days modified Rankin Scale (mRS) were ascertained. The time of recanalization since symptoms is defined by the time interval between recanalization and symptoms onset. Outcome was meas- ured by mRS at 30 days, NIHSS score after completion, 24 h and 30 days of the procedure. The SAS software was used to analyze the data. Results We analyzed 21 AIS patients (67% female and 33% male) who underwent SRT for MCA occlusion (52% (11) right MCA, 48% (10) left MCA) with mean age of 70.62 ± 13.94 years and mean admission NIHSS 16.76 ± 5.09. Complete (TICI3) and partial (TICI2b) recanalization was observed in 19 (90.50%) and 2(9.50%) respectively with mean passes of 1.71 ± 1. Time to recanalization from stroke onset was 230 ± 1160 min. Mean presenting NIHSS of 16.76 dropped to 7, 5 and 2 at immediate, 24 h and 30 days post SRT respectively. Good out- come (mRS £2) was observed in 15(66.13%) and poor outcome in 6(28.57%) including mortality in 2(9.5%). In univariate analy- sis recanalization time, immediate and 24 h post SRT NIHSS were predictors of outcome (p-value = 0.0039, 0.003 and 0.043 Electronic poster abstracts A44 J NeuroIntervent Surg 2015;7(Suppl 1):A1–114