Abstract 335: National Patterns Of Carotid Artery Stenting Utilization In Mechanical Thrombectomy Stroke Patients in the US

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Background Patients with large vessel occlusion due to high‐grade extracranial carotid stenosis may requireadjunctive carotid artery stenting (CAS) plus mechanical thrombectomy (MT) to prevent acuteischemic stroke (AIS) recurrence. Population‐level data on contemporary CAS utilization in MTare lacking. This study describes CAS utilization trends in MT patients in the United States (US)over the last decade. Methods We conducted a serial cross‐sectional study utilizing the 2010‐2021 National Inpatient Sample.All adult (>=18 years) primary MT admissions with and without CAS were identified usingInternational Classification of Diseases codes. Age and sex‐ specific prevalence of CAS in MTwere computed. Multivariable‐adjusted negative binomial regression models were used tocompare prevalence of CAS between various demographic subgroups and to compare in‐hospitalmortality or good outcome (routine home discharge) rates between CAS versus non‐CAS MTadmissions. Results Of 5,927,384 weighted AIS admissions from 2010‐2021, 195,677 (3.3%) underwent MT. 6.4%of these MT admissions underwent CAS but this proportion deferred significantly by age and sex(Figure 1a). Highest frequency of utilization was in men 60‐79 years (10.1%) and lowest use inwomen >=80 years (1.9%). (Figure 1a). Annual CAS volume in MT increased from 186 casesannually in 2010 to 2,340 cases in 2021, but the overall utilization rate of all MTs did notincrease significantly over time (Figure 1b). 85.4% of these procedures were performed on thesame day as MT and only 14.6% were performed on different days. 12.7% of CAS admissionshad carotid dissection vs 2.5% in the non‐CAS group. Only 0.4% of MT had carotidendarterectomy. After multivariable adjustment for clinical and hospital‐level factors, womenhad ≈50% lower prevalence of CAS vs men (adjusted prevalence ratio (APR) 0.51, 95%CI 0.46‐0.55) and Black admissions had 43% lower prevalence of CAS vs White admissions (APR 0.57,95%CI 0.49‐0.66). In multivariable models that included the National Institute of Health StrokeScale and other clinical factors CAS utilization was not associated with in‐hospital mortality(APR 0.86, 95%CI 0.72‐1.03) or good outcome (APR 0.93, 95%CI 0.85‐1.02) Conclusion Just over 6% of MT admissions across the period 2010‐2021 in the US underwent CAS. CASutilization rate did not change over time, but volume of utilization has increased by over 10‐fold,accompanying the increase in MT that has occurred over time. CAS is more frequently utilized in men and in White admissions in the US compared to women and Black admissions,respectively.