Trends in Thrombectomy Utilization in Stroke: Basilar Artery versus ICA/MCA (P7-5.003)

Abstract

<h3>Objective:</h3> In the current analysis, we compared the annual utilization of thrombectomy for Basilar Artery Occlusion (BAO) with internal carotid and middle cerebral artery (ICA/MCA) occlusion strokes. <h3>Background:</h3> Although the BAOCHE and ATTENTION trials have only recently demonstrated the effectiveness of thrombectomy for BAO stroke, the poor prognosis of acute BAO has encouraged providers to aggressively treat BAO in the absence of randomized trial data. <h3>Design/Methods:</h3> Stroke patients who presented to the emergency department between 2015 and 2019 were identified using the National Emergency Department Sample database. Patients were grouped by primary diagnosis of BAO or ICA/MCA to assess for thrombectomy likelihoods. Odds of thrombectomy were determined by multivariate logistic regression to account for hospital type, geographic location, and patient demographics. <h3>Results:</h3> Between 2015–2019 we identified a total of 1,721,207 stroke patients, of whom 12,620 patients had a BAO and 137,118 had ICA/MCA occlusions. Of the included patients 15.7% of BAO patients (95%CI 13.6%–17.9%) and 14.5% (95%CI 12.9%–16.1%) of ICA/MCA occlusions were treated with a thrombectomy. Within this time frame, thrombectomy usage increased from 1.5% (95% CI: 1.2%–1.9%) to 2.5% (95% CI: 2.1%–3.0%) for all stroke types. There was no difference in odds of thrombectomy between stroke types (OR: 0.86, 95% CI:0.70–1.06). <h3>Conclusions:</h3> Despite a lack of clinical trial data supporting thrombectomy in BAO, it is used just as frequently in US patients with BAO as patients with ICA/MCA occlusion stroke. These data suggest a lack of perceived equipoise in randomizing patients with BAO to thrombectomy in the US, and may be helpful in the design of future randomized trials in this population. <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.