Abstract TP321: Real World Outcomes in Patients With a Posterior Cerebral Artery Occlusion With a Low NIHSS

Abstract

Introduction: Observational studies have reported improved outcomes following endovascular treatment (EVT) for posterior cerebral artery (PCA) occlusions. Whether there is a benefit of EVT in patients with NIHSS <6 is less well understood. Methods: The National Inpatient Sample (2015-2020) was retrospectively queried for patients with a primary PCA occlusion with a NIHSS <6 and age>17 without a concomitant basilar artery occlusion (BAO). A secondary analysis including patients with a BAO was also performed. Treatment with best medical management (BMM) versus endovascular therapy (EVT) was compared using propensity score matching. Results: In this time frame, 31,175 patients presented with a PCA occlusion as the primary diagnosis and had a NIHSS<6. Of these patients, 8.8% of patients were treated with EVT. 31,050 patients did not have a concomitant BAO. In a propensity matched cohort of primary PCA and patients without a concomitant BAO, 2720 were treated with EVT and 2720 were treated with BMM. Patients treated with EVT had greater odds of routine discharge (adjusted OR 1.34, 95% CI 1.02 to 1.77, p=0.036) with no difference in length of hospital stay (adjusted β -0.35, 95% -0.83 to 0.13, p=0.15) or in-hospital death (adjusted OR 0.77, 95% CI 0.15 to 3.99, p=0.76) as compared to patients treated with BMM. Patterns were also similar when patients with a concomitant BAO were present (routine discharge adjusted OR: 1.67, 95% CI: 1.28-2.19, p<0.001). Conclusions: Our findings suggest potential real-world benefit for EVT in patients with a PCA occlusion with a low NIHSS, irrespective of concomitant BAO.