Karan Patel1, Kamil Taneja2, Michael Diaz3, Aleem Mohamed1, Sai Batchu1, Jesse Thon4, James Siegler4
1Cooper Medical School of Rowan University, 2Renaissance School of Medicine at Stony Brook University, 3University of Florida College of Medicine, 4Cooper University Hospital
Objective:
To evaluate the effectiveness of thrombectomy compared to medical management for patients with a basilar artery occlusion (BAO).
Background:
The effectiveness of thrombectomy to treat a BAO stroke has only recently been established. The BAOCHE trial and ATTENTION trial reported improvement in functional outcomes in Chinese patients with BAO treated with thrombectomy as compared to conventional medical management. These findings warrant validation in other populations before any definitive conclusions can be drawn about the effectiveness of thrombectomy for BAO.
Design/Methods:
Using the National Emergency Department Sample Database (NEDS), we retrospectively queried patients with a BAO between 2006-2019 in the United States. Patients were stratified into groups reflecting treatment with intravenous tissue plasminogen activator (tPA) alone, thrombectomy alone, or both tPA and thrombectomy. Multivariable logistic regression was performed to evaluate likelihood of death and length of hospital stay within all treatment groups.
Results:
Of the 2,998,237 stroke patients identified, 17,346 had a BAO, of whom 1,508 were treated only with thrombectomy, 1,697 were treated with tPA only, and 704 were treated with both thrombectomy and tPA. Patients treated with either dual therapy (OR: 2.88, 95% CI: 1.34-6.17) or thrombectomy-only (OR:1.95, 95% CI:1.64-2.33) had a higher death risk than those treated with tPA-only. Compared to patients treated with tPA-only, patients treated with dual therapy (b=4.02, 95% CI: 1.08-6.96) or thrombectomy-only (b=3.25, 95% CI: 2.60-3.90) had longer hospital stays. There was no difference in length of stay between those treated with dual therapy or thrombectomy-only.
Conclusions:
The present analysis did not find any associated mortality or length of stay benefits in patients treated with thrombectmoy compared to those treated with tPA. However, the nonrandomized allocation of treatment groups and lack of clinical severity indices limit the findings of this population-based analysis.