Real‐World Outcomes of Endovascular Thrombectomy for Basilar Artery Occlusion: Results of the BArONIS Study

Abstract

Objective To evaluate clinical outcomes of endovascular thrombectomy (EVT) for acute basilar artery occlusion (BAO) using population‐level data from the United States. Methods Weighted discharge data from the National Inpatient Sample were queried to identify adult patients with acute BAO during the period of 2015 to 2019 treated with EVT or medical management only. Complex samples statistical methods and propensity‐score adjustment using inverse probability of treatment weighting (IPTW) were performed to assess clinical endpoints. Results Among 3,950 BAO patients identified, 1,425 (36.1%) were treated with EVT [mean age 66.7 years, median National Institute of Health Stroke Scale (NIHSS) score 22]. On unadjusted analysis, 155 (10.9%) EVT patients achieved favorable functional outcomes (discharge disposition to home without services), while 515 (36.1%) experienced in‐hospital mortality, and 20 (1.4%) developed symptomatic intracranial hemorrhage (sICH). Following propensity‐score adjustment by IPTW accounting for age, stroke severity, and comorbidity burden, EVT was independently associated with favorable functional outcome [adjusted odds ratio (aOR) 1.25, 95% confidence interval (CI) 1.07, 1.46; p = 0.004], but not with in‐hospital mortality or sICH. In an IPTW‐adjusted sub‐group analysis of patients with NIHSS scores >20, EVT was associated with both favorable functional outcome (discharge disposition to home or to acute rehabilitation) (aOR 1.55, 95% CI 1.24, 1.94; p < 0.001) and decreased mortality (aOR 0.78, 95% CI 0.69, 0.89; p < 0.001), but not with sICH. Interpretation This retrospective population‐based analysis using a large national registry provides real‐world evidence of a potential benefit of EVT in acute BAO patients. ANN NEUROL 2023;94:55–60

Real-World Outcomes for Basilar Artery Occlusion Thrombectomy With Mild Deficits: The National Inpatient Sample

“…Unsurprisingly, the proportion of patients with BAO who underwent EVT across all NIHSS strata was higher in 1 recent analysis of the NIS using overlapping years. 8 It is likely the fact that more severe deficits attributed to BAO (according to NIHSS) drove this difference in thrombectomy rate between studies.…”

“…The primary outcome was a routine discharge, defined as discharge to home or self-care as in one previous analysis of BAO patients from the NIS. 8 For the primary analysis, a multivariable binary logistic regression model was used to estimate the odds of routine discharge in patients who underwent EVT versus BMM, with the following key covariates included a priori to the multivariable model: age, sex, race, hypertension, diabetes, dyslipidemia, atrial fibrillation, overweight, coronary disease, tobacco use, mCCI, NIHSS, and treatment with intravenous thrombolysis. Estimates are summarized using odds ratios (OR) with corresponding 95% CI.…”

“…The ICD-10 -Clinical Modification procedure code 03CG3ZZ (Extirpation of Matter from Intracranial Artery, Percutaneous Approach) and 03CG3Z7 (Extirpation of Matter from Intracranial Artery using Stent Retriever, Percutaneous Approach) codes were used to identify patients who underwent EVT, and the ICD-10 procedure code 3E03317 (Introduction of Other Thrombolytic into Peripheral Vein, Percutaneous Approach) and diagnosis code Z92.82 (status postadministration of tissue-type plasminogen activator in a different facility within the last 24 hours before admission to current facility) were used to identify patients who received thrombolytic treatment for BAO, as used previously. 8 Inclusion criteria in our study were limited to adult patients (aged ≥21 years, based on available NIS age category) with a NIHSS <10 (at time of admission) who were admitted between 2018 and 2020. Only patients with complete covariates (shown in Table 1) were included in the analysis.…”

“…Symptomatic intracranial hemorrhage was abstracted from the NIS using coding for intracerebral or subarachnoid hemorrhage and associated sequelae ( ICD-10-CM I69.0 and I69.1), as described previously. 8 For the primary outcome of routine discharge, subgroup analyses for each clinical and demographic covariate were performed using unadjusted, adjusted multivariable logistic regression, and adjusted multivariable logistic regression with PS matching was conducted to estimate the association between EVT and routine discharge for each subgroup. Interaction terms were calculated to determine potential differences between subgroups.…”

Association of Endovascular Thrombectomy Volume and Outcomes in Acute Ischemic Stroke: A National Inpatient Sample Study

“…9,10 We identified markers of stroke severity based on previous NIS studies analyzing EVT outcomes. 11,12 Markers of stroke severity included ICD-10 diagnoses related to level of consciousness (stupor and coma), infarct size (cerebral edema and herniation), neurological deficits (neglect, dysphagia, and aphasia), and reliance upon respiratory or nutritional support (mechanical ventilation, nasogastric tube, and parenteral nutrition). Additionally, the proportion of total AIS admissions undergoing EVT were collected.…”