O-027 Emergent versus delayed carotid artery stenting following intracranial thrombectomy for acute stroke with tandem occlusion

Abstract

<h3>Introduction</h3> At present, there is lack of consensus about the optimal timing of carotid artery stenting (CAS) following intracranial endovascular thrombectomy (EVT) for anterior circulation large vessel occlusions (LVO) presenting with tandem occlusion. We aimed to evaluate the safety of emergent CAS performed concurrently with EVT in this patient population. <h3>Methods</h3> We utilized the Nationwide Readmissions Database 2016-2017 to identify patients admitted due to acute ischemic stroke who underwent anterior circulation EVT as well as CAS either on the same day or within 90 days of initial presentation. Survey design methods were used to generate national estimates. Univariate and multivariable logistic regression analyses were performed to evaluate clinical outcomes in patients who underwent emergent CAS (same day as EVT) in reference to those with delayed CAS (day 2-90). <h3>Results</h3> We identified 1,601 hospitalizations meeting the study inclusion criteria (mean±SD age: 66.2±12.4 years, female 29.5%). Of these, 1,392 (87.0%) underwent emergent CAS and 209 (13.0%) underwent delayed CAS. Baseline characteristics between the two groups were similar except patients with emergent CAS were less likely be on anti-thrombotic medications and to have previous history of stroke; and patients with delayed CAS had lower disease severity, were more likely to have received intravenous thrombolysis, to have private insurance and to be admitted at large, teaching hospitals. After adjusting for age, sex, and the differences in baseline characteristics, patients with emergent CAS had higher odds of in-hospital mortality [odds ratio (OR) 6.17, 95% confidence interval (CI) 1.36-27.92, p 0.018], prolonged mechanical ventilation (OR 5.24, 95% CI 1.46-18.80, p 0.011), and discharge disposition other than to home (OR 1.88, 95% CI 1.01-3.49, p 0.047). Other outcomes including intracranial hemorrhage, gastrostomy tube placement, length of stay, and hospital charges did not differ between the two groups. <h3>Conclusions</h3> Delayed CAS might be a safer approach for carotid revascularization for patients presenting with tandem anterior circulation lesions undergoing EVT. <h3>Disclosures</h3> <b>A. Garg:</b> None. <b>C. Zevallos:</b> None. <b>D. Quispe Orozco:</b> None. <b>A. Mendez Ruiz:</b> None. <b>M. Farooqui:</b> None. <b>O. Zaidat:</b> None. <b>S. Ortega:</b> None.