Abstract WP199: Outcomes Following Posterior Cerebral Artery Thrombolysis vs Medical Management in those with Atrial Fibrillation

Abstract

Background: The benefits of endovascular thrombectomy (EVT) for posterior cerebral artery (PCA) occlusion remain controversial, but intravenous thrombolysis (IVT) has proven benefit across nearly all ischemic stroke types. We isolated a cohort of patients with likely embolic PCA occlusions (those with atrial fibrillation) and compared outcomes associated with IVT and EVT versus medical management (MM). Methods: The National Inpatient Sample (2015-2020) was retrospectively queried for patients with a primary diagnosis of a PCA occlusion (without a concomitant basilar occlusion, BAO) with a secondary diagnosis of atrial fibrillation. Descriptive statistics and propensity score matching for IVT with multivariable logistic regression were used to determine the odds of routine discharge, hospital length of stay, and death between those treated with IVT and EVT versus MM. Results: Of the 107,525 screened patients with a primary diagnosis of a PCA occlusion, 27730(25.7%) had a secondary diagnosis of atrial fibrillation, of whom 3010 underwent IVT. In a 1:1 matched cohort(n=3010 per group), patients treated with IVT had greater odds of discharge to home (adjusted OR 1.87,95% CI 1.22 to 2.87) with no difference in length of hospital stay (adjusted β 0.26, 95% -0.71 to 1.22) or in-hospital death (adjusted OR 0.81, 95% CI 0.27 to 2.47) as compared to patients treated with MM. These trends were preserved in a secondary analysis of unmatched patients in multi variable regression models, and no significant benefit of EVT for these outcomes (OR 1.75, 95%CI 0.62-4.93). Patterns were also similar when patients with a concomitant BAO were included (routine discharge adjusted OR for IVT: 1.57, 95% CI:1.03-2.38). Conclusion: Our findings show a potential real-world benefit for IVT in patients with a PCA occlusion secondary to presumed cardio embolism, but no significant advantage with EVT.