Affiliation:
1. Cooper Medical School of Rowan University Camden NJ
2. Cooper Neurological Institute Cooper University Hospital Camden NJ
3. Renaissance School of Medicine at Stony Brook University Stony Brook NY
4. Warren Alpert School of Medicine at Brown University Providence RI
5. Department of Neurology Rhode Island Hospital Providence RI
6. Department of Neurology and Neurosurgery Westchester Medical Center Valhalla NY
7. Department of Neurology University of Chicago Chicago IL
8. Boston Medical Center Boston University Chobanian and Avedisian School of Medicine Boston MA
Abstract
Background
In 2019 and 2020, 2 randomized trials of basilar artery occlusion (BAO) thrombectomy reported no improvement in functional outcomes with thrombectomy, despite observational evidence. The objective of this study was to assess whether neutral clinical trials may have influenced BAO thrombectomy practice.
Methods
The National Inpatient Sample (2018–2020) was queried for US patients with BAO, and comparisons were made between patients admitted in 2020 versus 2018 to 2019 for the primary outcome of thrombectomy. Unadjusted and adjusted multivariable regression was used, accounting for demographic and clinical covariates, with propensity‐score matching to balance clinical and hospital‐level characteristics between years.
Results
Of the 14 945 patients with BAO, 3,605 (24.1%) underwent thrombectomy,with an increase in the unadjusted rate of thrombectomy between 2020 and 2018–2019 (26.9% vs 22.9%,
P
= 0.04). Following multivariable adjustment, BAO thrombectomy was not independently associated with a year of treatment (adjusted odds ratio [aOR] 1.21, 95% confidence interval [CI] 0.95–1.54,
P
= 0.12). Thrombectomy was independently associated with having a NIHSS of 10–19 (OR: 3.67, 95% CI: 2.79–4.83,
P
< 0.01) or >19 (OR: 5.80, 95% CI: 4.41–7.64) versus a NIHSS of 10, while uinsured patiends hadal owe likelihood of receiving a thombectomy (OR: 0.49, 95% C: 0.26–0.92). These relationships were preserved in the PSM cohort, and admission year lacked association with thrombectomy for BAO (aOR: 1.10, 95% CI: 0.83–1.45,
P
= 0.52).
Conclusion
Following publication of neutral BAO randomized clinical trials in late 2019 and 2020, there was no significant change in thrombectomy rate among US patients with BAO. The latest trials support thrombectomy for select patients with moderate‐to‐severe BAO symptoms, and this appears consistent with the practice of US clinicians before these trials.
Publisher
Ovid Technologies (Wolters Kluwer Health)