Abstract Body: Background: Cerebral amyloid angiopathy (CAA) is a hemorrhagic cerebrovascular disease that is thought to be due to excess protein deposition in vessel walls that lead to fragility and increase the risk of rupture. Whether intravenous thrombolysis (IVT) is safe and effective for acute ischemic stroke (AIS) patients with CAA is largely unknown.
Methods: This was an explorative analysis of a nationwide database of hospitalizations in the United States. AIS patients with CAA were identified by ICD-10 codes and included in the study, and cases were divided into IVT and no-IVT groups. Propensity score matching was performed to balance treatment groups, and additional multivariable logistic regressions were used for doubly robust analyses. Primary outcome was routine discharge to home with self-care. Secondary outcomes include discharge to home, in-hospital mortality, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH).
Results: 5,100 patients were identified; 498 (9.8%) received IVT. After propensity score matching and doubly robust analyses with additional multivariable logistic regression, IVT was associated with better discharge outcomes (Figure 1), with significantly higher odds of routine discharge (adjusted OR 1.77 [95%CI 1.12-2.80], p=0.015) despite higher odds of ICH (aOR 4.00 [95%CI 2.79 to 5.75], p<0.001), and SAH (aOR 2.42 [95%CI 1.41-4.16], p=0.001). IVT was not associated with significantly different odds of home discharge (aOR 0.99 [95%CI 0.69-1.41], p=0.94) or in-hospital mortality (aOR 0.91 [95%CI 0.45-1.84], p=0.80). Mediation analyses revealed that the higher rates of ICH associated with IVT treatment led to a statistically significant suppression of IVT’s association with higher odds of routine discharge (ACME of -0.03 [-0.01 to -0.06], p=0.004 and proportion suppressed of 49.3% [95%CI 8.0% to 360.6%], p=0.038).
Conclusion: IVT for AIS patients with CAA was associated with higher odds of short-term excellent outcomes despite higher odds of ICH and SAH, and it did not increase the odds of early mortality.