Abstract 060: Endovascular Thrombectomy for Posterior Cerebral Artery in the National Inpatient Sample (EaT PeCAN pIeS)

Abstract

Introduction Posterior cerebral artery acute ischemic strokes (PCA‐AIS) comprise around 2% of all acute ischemic strokes and often results in significant long‐term deficits. Current guidance regarding endovascular thrombectomy (EVT) for PCA occlusion is insufficient as no randomized trials exist. Methods A real‐world retrospective National Inpatient Sample database analysis compared medical management (MM) versus EVT for PCA strokes. Propensity score matching based on medical co‐morbidities was applied to adjust for nonrandomization. Subgroup analysis based on their initial stroke severity was conducted, comparing outcomes within subgroups of NIHSS 0‐9, 10‐19, and ≥20. Additional subgroup analysis was conducted to compare patients receiving IVT vs those not. Results The study included 19,655 patients, 18,910 MM, and 745 EVT. Among the unmatched patients, the EVT cohort had significantly higher NIHSS (10.21 vs 4.67, p < 0.001). In the unmatched analysis, the EVT‐treatment group also demonstrated lower rates of favorable functional outcomes, functional independence, and higher rates of ICH and in‐patient mortality. Matched analysis showed no differences in functional outcomes but higher inpatient mortality and ICH rates in the EVT treatment group. Subgroup analysis identified higher odds of favorable functional outcomes and functional independence associated with EVT among patients presenting with intermediate NIHSS (10‐19). On further subgroup analysis, this EVT benefit was maintained only among patients receiving IVT. Conclusion This analysis demonstrates that, across the population, patients receiving EVT for PCA AIS are more severe and in general, have worse outcomes than patients receiving MM only. However, on matched analysis there does seem to be a significant clinical benefit associated with EVT for patients presenting with an NIHSS between 10‐19 and this benefit appears to be associated with patients who have also received IVT. More research is needed for optimal patient selection when considering EVT for PCA.