Abstract WP17: Rates and Outcomes of Neurosurgical Evacuation for Thromboytic Related Intracerebral Hemorrhage in Patients with Acute Ischemic Stroke

Abstract

Background: Thrombolytic related intracerebral hemorrhage (ICH) is an infrequent occurrence in patients with acute ischemic stroke. There is controversy surrounding the value of neurosurgical evacuation of hematomas and decompression in these patients and whether such availability is a necessary pre-requisite for administration of thrombolytics. Objective: To report the frequency and outcomes of patients who suffer from thrombolytic related ICH and undergo a craniotomy. Materials/Methods: Using the Nationwide Inpatient Sample (NIS) from 2002 to 2010, acute ischemic stroke patients who suffered from thrombolytic related ICH were identified using ICD-9 codes. Patients were divided into those who received craniotomy and those who received medical management alone. Discharge destination and mortality were primary endpoints. Results: A total of 7359 patients suffered thrombolytic related ICH, 125 (1.7%) of those patients underwent craniotomy and 7234 patients (98.3%) received medical treatment alone. Patients who underwent craniotomy were younger (58±5 versus 72±11 years, p=0.09). Patients in the craniotomy group were frequently in extreme severity APR-DRG category compared with medical management group (92.2% versus 55.5%, p=0.0003). The craniotomy group had greater requirements for gastrostomy (47.8% versus 16.7%, p=0.02) and mechanical ventilation (55% versus 13.8%, p=0.005) compared with the medical management group. The mean length of stay was also longer in the craniotomy group (21.5±7 versus 10±2 days, p<0.0001). The in-hospital mortality and discharge to nursing home/long-term care facility was 24.2% and 72% among those treated with craniotomy, respectively. The corresponding proportions were 30.5% and 57% for medically treated group (p=0.5 and p=0.1, respectively). Conclusion: Emergent craniotomy for thrombolytic related hematoma evacuation or decompression in acute stroke is a salvage treatment offered to a small proportion of patients. There may be evidence that this reduces mortality, however long term disability may be higher in those patients. More detailed analysis may be required to understand the impact of emergent craniotomy on patient disability in thrombolytic related hemorrhage for acute ischemic stroke.