Abstract TP205: Intracranial Stenting With Mechanical Thrombectomy in Acute Ischemic Stroke in the United States

Abstract

Background and Purpose: Large vessel occlusion secondary to intracranial atherosclerotic disease (ICAD-LVO) has an estimated prevalence of 10-30%. Registry-based reports from high volume centers indicate that about 4-7% of mechanical thrombectomy (MT) due to LVO are accompanied with intracranial rescue stenting in the US, yet the trend and utilization of rescue stenting in US is unknown. Methods: Analysis of US National Inpatient Sample of strokes with mechanical thrombectomy with or without concomitant intracranial stenting from October 1st, 2016, to December 31st, 2020, was performed. Patient- and hospital-level characteristics were analyzed. Outcomes included favorable disposition (discharged to home) and in-hospital mortality. Results: Among 68,975 of stroke MT with recorded NIHSS during the study period (51.1% women; mean age, 69.1 [SD, 14.6] years; mean NIHSS score of 15.1 [SD, 7.7]), 1,635 (2.3%) underwent concomitant intracranial stenting (44% women; mean age, 64.8 [SD, 13.7] years; mean NIHSS score of 13.8 [SD, 8.1]). Characteristics associated with intracranial stent utilization were male sex, history of diabetes, hypertension, or chronic kidney disease, absence of atrial fibrillation or CHF, and southern US region. Favorable outcome was achieved in 23.6% of MT with stenting versus 32.3% without stenting (P<0.001). In-hospital mortality occurred in 17.1% of MTs with stenting versus 10.5% without stenting (P<0.001). In multivariable analysis among MTs with concomitant intracranial stenting, favorable outcome was associated with lower presenting NIHSS (OR, 0.91 [95% CI, 0.87-0.95], P<0.001), and absence of DM (OR, 0.41 [95% CI, 0.20-0.85], P<0.01). In-hospital mortality was associated with male sex (OR, 3.08 [95% CI, 1.38-6.87], P=0.005) and concomitant IV lytic administration (OR, 2.45 [95% CI, 1.01-5.96], P=0.02). Conclusions: In US practice, less than 3/100 MT’s are performed with concomitant intracranial stenting which is well below the prevalence of failed thrombectomy rates due to underlying ICAD-LVO. Further studies are needed to improve outcomes in this subset of patients.