Abstract WP48: Real-world Outcomes Following Mechanical Thrombectomy and tPA Treatment of Acute Ischemic Strokes

Abstract

Introduction: Tissue plasminogen activator (tPA) and mechanic thrombectomy (MT) are the gold-standard treatment options for acute ischemic stroke (AIS). While the short-term benefits and outcomes of these treatments are well studies, the long-term “real world” outcomes are less well understood. Hypothesis: We hypothesize that readmission reasons and rates will differ between strokes treated with MT or tPA. Methods: We obtained de-identified clinical data on 37,381 AIS cases admitted to 177 US hospitals. AIS were grouped by treatment type MT and tPA. 30-day all-cause readmission data was captured for all AIS cases studied. The readmission reasons were classified according to the primary (first) ICD-10 code. Odds ratios (OR’s) were computed for the MT and tPA groups using Fischer’s exact tests with Bonferroni correction for multiple comparisons. Results: Overall, 10 times more patients received tPA treatment (n=33,992) than MT (n=3,389) with a slightly higher rate of male patients receiving tPA (52 %) than female patients, while the opposite was true for MT (48 %). The leading reason for readmission was the group of symptoms related to the circulatory system (14-23 % of patients, p<0.001), more specifically to nontraumatic intracerebral hemorrhage. The intracerebral hemorrhage was also responsible for explaining the largest difference between post-MT and post-tPA re-admittance as it showed a much higher prevalence (p<<0.001) within the post-MT population than in the post-tPA group. Conclusions: The statistical analysis confirmed the hypothesis that MT, tPA, and the combined treatment differently affect the recurrence of cerebrovascular symptoms. Among those, the leading reason was nontraumatic intracerebral hemorrhage, which occurs much more likely following MT, than following tPA treatment or following the co-application of MT and tPA.