Outcomes of Endovascular Mechanical Thrombectomy and Intravenous Tissue Plasminogen Activator for the Treatment of Vertebrobasilar Stroke
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Background and Purpose Aggressive treatment of posterior-circulation occlusions is important due to the high rates of morbidity and mortality associated with these infarctions. Alarge administrative database was evaluated to determine the outcomes of mechanical thrombectomy and intravenous tissue plasminogen activator (IV-tPA) for the treatment of posteriorcirculation (vertebrobasilar) strokes. Outcomes were compared across age groups. Methods The United States Nationwide Inpatient Sample was used to evaluate the outcomesof patients treated for posterior-circulation acute ischemic stroke between 2006 and 2010. Patients who underwent endovascular mechanical thrombectomy and IV-tPA were selected. Primary outcomes were discharge status and mortality; secondary outcomes were length of stay,rate of intracranial hemorrhage, tracheostomy, and percutaneous endoscopic gastrostomy/jejunostomy tube placement. Outcomes were grouped according to age (i.e., <50, 50–64, and ≥65years). Chi-squared test and Student’s t-test were used for comparisons of categorical and continuous variables, respectively. Results During 2006–2010 there were 36,675 patients who had discharge International Classification of Diseases (9th edition) codes indicating posterior-circulation strokes. Of these, 631(1.7%) underwent mechanical thrombectomy and 1554 (4.2%) underwent IV-tPA. The in-hospital mortality rate for mechanical thrombectomy patients was significantly lower for thoseaged <50 years than for those aged 50–64 years (30.4% versus 47.4%, p<0.01) and those aged≥65 years (30.4% versus 43.0%, p≤0.01). Age had no effect on the in-hospital mortality for IVtPA patients, with an incidence of 22.7% for patients aged <50 years, compared to 25.4% forpatients aged 50–64 years (p=0.46) and 23.0% for patients aged ≥65 years (p=0.92). Conclusions Patients requiring IV-tPA and/or mechanical thrombectomy for the treatment ofposterior-circulation strokes suffer from high mortality rates. Increased age is associated withsignificantly higher mortality rates among posterior-circulation stroke patients who require mechanical thrombectomy.
Abstract
Background and Purpose Aggressive treatment of posterior-circulation occlusions is important due to the high rates of morbidity and mortality associated with these infarctions. Alarge administrative database was evaluated to determine the outcomes of mechanical thrombectomy and intravenous tissue plasminogen activator (IV-tPA) for the treatment of posteriorcirculation (vertebrobasilar) strokes. Outcomes were compared across age groups. Methods The United States Nationwide Inpatient Sample was used to evaluate the outcomesof patients treated for posterior-circulation acute ischemic stroke between 2006 and 2010. Patients who underwent endovascular mechanical thrombectomy and IV-tPA were selected. Primary outcomes were discharge status and mortality; secondary outcomes were length of stay,rate of intracranial hemorrhage, tracheostomy, and percutaneous endoscopic gastrostomy/jejunostomy tube placement. Outcomes were grouped according to age (i.e., <50, 50–64, and ≥65years). Chi-squared test and Student’s t-test were used for comparisons of categorical and continuous variables, respectively. Results During 2006–2010 there were 36,675 patients who had discharge International Classification of Diseases (9th edition) codes indicating posterior-circulation strokes. Of these, 631(1.7%) underwent mechanical thrombectomy and 1554 (4.2%) underwent IV-tPA. The in-hospital mortality rate for mechanical thrombectomy patients was significantly lower for thoseaged <50 years than for those aged 50–64 years (30.4% versus 47.4%, p<0.01) and those aged≥65 years (30.4% versus 43.0%, p≤0.01). Age had no effect on the in-hospital mortality for IVtPA patients, with an incidence of 22.7% for patients aged <50 years, compared to 25.4% forpatients aged 50–64 years (p=0.46) and 23.0% for patients aged ≥65 years (p=0.92). Conclusions Patients requiring IV-tPA and/or mechanical thrombectomy for the treatment ofposterior-circulation strokes suffer from high mortality rates. Increased age is associated withsignificantly higher mortality rates among posterior-circulation stroke patients who require mechanical thrombectomy.
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