Abstract WMP1: Mechanical Thrombectomy Alone vs Combined Mechanical Thrombectomy With Intravascular Thrombolysis in Patients With Acute Ischemic Stroke-Analysis on Propensity Matched National Cohort

Abstract

Background: Comparative analysis between Mechanical thrombectomy (MT) alone vs Combined mechanical thrombectomy with intravascular thrombolysis (IVT) in patients with Acute ischemic stroke (AIS) has never been studied on nationwide patient population. Method: Nationwide Readmissions Database (NRD) from 2010-14 was utilized to identify AIS using appropriate ICD-9CM codes in primary diagnosis fields. MT was identified by ICD9 procedure code 39.74 and IVT by 99.10 in any procedural field. We used Greedy’s algorithm for propensity score match (1:1) to adjust for clinically important confounders and simple logistic regression to generate odds ratio. Results: We identified 10,344 patients who underwent combined MT and IVT therapy (Mean age 67.9 years, female 49.9%) and 10,428 who underwent MT alone (Mean age 67.7 years, female 50.8%). In hospital mortality among combined group was 19.7% vs 17.7% in MT alone (p value=<.001), 30-day readmission 10.8% vs 10.7% (p value=0.843) and Mean Length of stay (LOS) 13 days vs 13 days (p value=0.366). After propensity match (1:1) we identified 3,844 matched pairs without any statistically significant difference in baseline characteristics. Among combined group vs MT alone group, cardiac complication was (4.2% vs 3.9%, P value=0.524), Major Bleeding (24.4% vs 24.4%, P value=0.958), Sepsis (4.9% vs 4.2%, P value=0.154), AKI requiring dialysis (0.2% vs 0.2%, P value=0.438), in hospital mortality (19.3% vs 17.6%, P value=0.064),30-day readmission (11.1% vs 11.4%, P value=0.613), Mean LOS (13.5 days vs 12.9 days, P value=0.298), Mean Cost of hospitalization $(48,950 vs 52,270 P value=<.0001). Conclusion: Our study represents that treatment of AIS patients with combined MT and IVT therapy does not appear to provide clinical and statistical advantage over MT alone as suggested by previous studies. Further research exploring impact of these therapy on outcomes including mortality benefit and complication rates in AIS is warranted.