Objective:

To determine the long-term survival and risk of new ischemic stroke among acute ischemic stroke patients who did and did not undergo mechanical thrombectomy (MT).

Background:

Previous studies have focused on 90-day outcomes in acute ischemic stroke patients who undergo mechanical thrombectomy (MT), although long-term outcomes are not well understood.

Design/Methods:

We analyzed 4,123 acute ischemic stroke patients who underwent MT and 4,123 propensity-matched controls of acute ischemic stroke patients who did not undergo MT using the Cerner Real World data. The risk of death or palliative care and new ischemic stroke following >90 days post-admission was ascertained using Cox proportional hazards regression analysis to adjust for potential confounders. We also estimated the rate of new stroke and palliative care-free survival using Kaplan Meir survival analysis.

Results:

Among 4,123 acute ischemic stroke patients who underwent MT, 2,756 patients either died or received palliative care or developed new ischemic stroke (median follow-up period of 762.5 days post initial stroke admission; interquartile range Q1=341 days, Q3=1,343 days). The risk of new ischemic stroke, palliative care, or death was significantly higher in acute ischemic stroke patients who underwent MT compared with those who did not undergo MT (odds ratio [OR], 1.35, 95% CI, 1.28-1.43) after adjustment for potential confounders. The risk of palliative care or death was not significantly different (OR, 1.05, 95% CI, 0.91-1.2), but the risk of new stroke was significantly higher (OR, 1.42, 95% CI, 1.34-1.51) among patients who underwent MT. The 2-year new stroke and palliative care-free survivals were 37.9% and 50.2% among patients who did or did not undergo MT, respectively.

Conclusions:

We observed that the risk of new ischemic stroke, palliative care, or death after 90 days was significantly higher among acute ischemic stroke patients who undergo MT highlighting the need for dedicated long-term preventive interventions in this patient population.