Abstract TP191: National Trends in Rescue Therapy for Failed Thrombectomy 2009-2020

Abstract

Introduction: For a subset of patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) mechanical thrombectomy with a stent retriever and/or aspiration is insufficient to revascularize the target artery. Rescue therapy with angioplasty alone or with stenting has been utilized. This study assesses the longitudinal trends for adjunctive treatments following failed thrombectomy in the U.S. Methods: We performed a data search from the National Inpatient Sample (NIS) database using ICD9 and ICD10 procedure codes from 2009 through 2020. Data was collected for patients with stroke who underwent thrombectomy for LVO and subsequent angioplasty or angioplasty and stenting. The use of drug eluting stents, patient demographics, regional trends, length of stay, and mortality statistics were also assessed. Results: Between 2009 and 2020, the NIS data shows a significant increase in the use of stenting as adjunctive therapy to thrombectomy for LVO. In 2009, stenting with thrombectomy in LVO represented 5.6% (25/443) of patients stented with stroke from ICAD. In 2020, these cases represented 48.6% (520/1,070) of the patients stented. Over the study period, this increase in stent use during LVO treatment was significant (p<0.001). There has been a mild increase in the use of drug eluting stents in rescue therapy, but not as significant as bare metal stents. Angioplasty as an adjunct to thrombectomy for LVO has steadily increased over the study period, with 87 cases in 2009 and 265 cases in 2020, representing a 205% increase. Conclusion: There has been a progressive, significant increase in the number of rescue procedures for failed thrombectomy over the study period with stent procedures outnumbering angioplasty alone. Referencing published data these cases represent approximately 2-3% of the total number of thrombectomies performed for AIS.