Abstract TP41: Similar Outcomes of Endovascular Ischemic Stroke Treatment Performed by Interventional Radiologists and Neuro Interventional Fellowship Trained Physicians

Abstract

Introduction: Endovascular stroke treatment (EVT) may be provided by physicians with varying specialty training. It is possible that physicians without dedicated neurointerventional training will have outcomes inferior to physicians with such dedicated training. Methods: Eight academic or community hospitals who provide EVT performed by interventional radiology (IR) and neurointerventional (NI) physicians (neurointerventional radiology, endovascular neurosurgery, or interventional neurology) in the same institution submitted sequential retrospective data limited to the era of modern clot extraction devices. Clinical outcome (modified Rankin score [mRS]) and successful revascularization (modified Thrombolysis in Cerebral Infarction [mTICI]) were compared between specialties, stratified for treating hospital, patient age, stroke severity, and clot location. Results: A total of 1079 patients were entered (661 treated by IR and 418 treated by NI) and 90 day mRS was available for 1013 patients (632 treated by IR and 381 treated by NI). For IR vs NI, median stroke onset to puncture was 220 vs 217 minutes (p=0.25), median door to puncture was 67 vs 75 minutes (p=0.18), successful revascularization (mTICI 2b or higher) was 82% vs 84% (p=0.38), symptomatic intracranial hemorrhage was 7.8% vs 6.7% (p=0.58), emboli to new territory was 2.1% vs 4.5% (p=0.22), 90 day mRS 0-1 was 30% vs 35% (p=0.06), and 90 day mRS 0-2 was 43% vs 50% (p=0.03). There was no significant difference in outcomes for clot locations in the internal carotid, M-1, M-2, or basilar arteries. When outcomes were adjusted for hospital, patient age, and stroke severity, physician specialty was not a significant predictor of mRS 0-1 (p=0.687 odds ratio 0.940, confidence interval 0.694-1.272) or mRS 0-2 outcome (p=0.695 odds ratio 0.944, 95% confidence interval 0.707-1.260). Conclusion: There was no significant difference in procedural or clinical outcome for EVT performed by IR vs NI physicians.