Abstract
Background and Purpose: Large vessel occlusion strokes are less likely to respond to intravenous thrombolytics (IV TPA) with recent endovascular treatment (EVT) studies showing superiority of EVT vs IV TPA alone. Our study aims to compare outcomes and hospital charges for strokes treated with either EVT alone or with IV TPA+EVT. Methods: We utilized our prospectively maintained endovascular database and analyzed all the patients who underwent EVT, categorizing them into IV TPA+EVT and EVT alone, comparing total encounter charges at our hospital between the two groups. We collected baseline demographics, clinical characteristics, admission, 24-hour, discharge, and 3-months NIHSS, and modified Rankin Scale (mRS) at discharge and 90 days follow up. Hemorrhage rates were also recorded. Median NIHSS and mRS for the two groups were compared using the Mann-Whitney U test. Results: 220 patients analyzed, 123 (55.9%) received EVT only and 97 (44.1%) received IV TPA+EVT. There was no statistical difference in baseline demographics, clinical characteristics, or NIHSS score on admission (Table 1). There was no difference in recanalization (p=.33) or favorable outcome (p=.997). There was a higher rate of intracranial hemorrhage in the IV TPA+EVT group vs EVT only group, 20 (20.6%) vs 10 (8.1%) respectively (p = .01). The mean [SD] total hospital encounter charges were $227,697.65 [±88,141.67] for EVT only group and $281,923.08 [±147,638.97] for IV TPA+EVT group (p=.001). Charges for IV TPA+EVT were $59,275.70 [95%CI (2636.13-115915.28)] higher than for EVT only group after adjusting for confounders (p=.04). Conclusions: The use of IV TPA did not improve functional outcomes for those patients undergoing combined endovascular therapy. Combined therapy was associated with significantly higher charges and increased hemorrhage rates than EVT alone. Prospective studies are warranted to study the cost/benefit ratio for IV TPA in combination with EVT.
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