Thrombectomy versus tPA in Basilar Artery Occlusion Stroke (P7-5.012)

Abstract

<h3>Objective:</h3> To evaluate the effectiveness of thrombectomy compared to medical management for patients with a basilar artery occlusion (BAO). <h3>Background:</h3> The effectiveness of thrombectomy to treat a BAO stroke has only recently been established. The BAOCHE trial and ATTENTION trial reported improvement in functional outcomes in Chinese patients with BAO treated with thrombectomy as compared to conventional medical management. These findings warrant validation in other populations before any definitive conclusions can be drawn about the effectiveness of thrombectomy for BAO. <h3>Design/Methods:</h3> Using the National Emergency Department Sample Database (NEDS), we retrospectively queried patients with a BAO between 2006–2019 in the United States. Patients were stratified into groups reflecting treatment with intravenous tissue plasminogen activator (tPA) alone, thrombectomy alone, or both tPA and thrombectomy. Multivariable logistic regression was performed to evaluate likelihood of death and length of hospital stay within all treatment groups. <h3>Results:</h3> Of the 2,998,237 stroke patients identified, 17,346 had a BAO, of whom 1,508 were treated only with thrombectomy, 1,697 were treated with tPA only, and 704 were treated with both thrombectomy and tPA. Patients treated with either dual therapy (OR: 2.88, 95% CI: 1.34–6.17) or thrombectomy-only (OR:1.95, 95% CI:1.64–2.33) had a higher death risk than those treated with tPA-only. Compared to patients treated with tPA-only, patients treated with dual therapy (b=4.02, 95% CI: 1.08–6.96) or thrombectomy-only (b=3.25, 95% CI: 2.60–3.90) had longer hospital stays. There was no difference in length of stay between those treated with dual therapy or thrombectomy-only. <h3>Conclusions:</h3> The present analysis did not find any associated mortality or length of stay benefits in patients treated with thrombectmoy compared to those treated with tPA. However, the nonrandomized allocation of treatment groups and lack of clinical severity indices limit the findings of this population-based analysis. <b>Disclosure:</b> Karan Patel has nothing to disclose. Mr. Taneja has nothing to disclose. Mr. Diaz has nothing to disclose. Mr. Mohamed has nothing to disclose. Mr. Batchu has nothing to disclose. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. An immediate family member of Dr. Thon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Genentech. Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Focus group participant with Alexion. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Ceribell. Dr. Siegler has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AstraZeneca.