Endovascular Thrombectomy for Stroke in Patients with Low NIHSS Scores and Outside the Thrombolysis Window: A Nationwide Inpatient Sample Analysis 2016-2019
Prabandh Buchhanolla1, Mohammad Sheikh2, Muhammad Ayub1, Omar Elsekaily3, Monika Thapa4, Jordyn Courville1, Lakshmi Chandaluri1, Saurabh Kataria1, Rahul Shah5, Himanshu Chokhawala6
1LSUHS, 2LSU Health Shreveport, 3LSU shreveport, 4Department of Neurology, 5LSU Shreveport, 6LSUHSC - SHreveport
Objective:
To assess safety and short-term functional outcomes of Endovascular Thrombectomy (EVT) in patients with minor acute strokes with NIHSS ≤ 6 without thrombolysis (tTA)
Background:
Uncertainty persists surrounding the therapeutic benefit of EVT without thrombolytics, in treatment of patients with minor acute ischemic strokes (NIHSS <6). There is a proven benefit of EVT in moderate to severe strokes in large randomized clinical trials, but there is limited evidence in literature on the effect of EVT in low NIHSS group
Design/Methods:
We used the Nationwide Inpatient Sample (NIS) database from 2016 to 2019 to identify patients with Acute Ischemic Stroke. We selected patients with NIHSS ≤ 6, who did not receive thrombolysis. We compared outcomes of patients who received endovascular thrombectomy to those who did not, including inpatient mortality, length of stay, and discharge disposition (home vs. rehabilitation facility) as dependent variables. We used chi-squared tests for categorical variables and t-tests for continuous variables in univariate analysis. We used logistic and linear regression in multivariate analysis to adjust for comorbidities (hypertension, diabetes mellitus, obesity, and smoking)
Results:
A total of 426,145 patients were extracted with given selection criteria. Mean age of 66 vs 68 (p<0.001) in EVT vs no EVT group. Overall, EVT group is associated with increased in hospital mortality (OR 8.693, CI 7.63-9.90, p <0.001), increased risk of discharging to Rehab facility (RR 1.42 CI 1.33-1.51, p<0.001) and increased length of stay in the hospital 5.73 vs 3.76 (β=1.9, p <0.001)
Conclusions:
Our study found that patients with low of NIHSS ≤ 6 who received endovascular thrombectomy (EVT) without thrombolytics had worse outcomes, including higher in-hospital mortality, more frequent discharge to rehabilitation facilities, and longer hospital stays