Abstract TP11: National Trends in Utilization and Outcomes of Emergent Carotid Artery Stent Placement in Acute Ischemic Stroke Patients

Abstract

Background: Subsequent to recent trials of carotid artery stent placement (CAS), emergent stent placement in acute ischemic stroke is being considered more frequently as part of the endovascular treatment. Objective: To evaluate trends in utilization of emergent CAS in acute ischemic stroke and to compare rates of death and disability with those treated with endovascular treatment without CAS. Methods: We obtained data for patients admitted to hospitals in the United States between 2004 to 2009 with a primary diagnosis of ischemic stroke using the Nationwide inpatient sample, a nationally representative data of acute care hospitalizations. We determined the rate of utilization of emergent CAS as part of endovascular treatment and outcomes according to use of emergent CAS or not. Outcomes were classified as minimal disability, moderate to severe disability, and death based on discharge disposition. Results: Of the 12,720 patients who underwent endovascular treatment, 1000 patients had emergent CAS (mean age 65 ± 12.8 years). The estimated number of patients undergoing emergent CAS increased by 7 fold (46 in 2004 to 336 in 2009). The rates of intracranial hemorrhage remained unchanged throughout the 6 years. The rates of none-minimal disability were significantly higher (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.3-3.1, p value=0.001) and in-hospital mortality was significantly lower [OR 0.6, 95% CI 0.4-0.9, p value=0.009] among patients who underwent endovascular treatment with emergent CAS after adjusting for potential confounders. Conclusion: There has been a significant increase in the proportion of acute ischemic stroke patients receiving emergent CAS with high rates of favorable outcomes and low rates of in-hospital mortality.