Abstract Body: Introduction: Medical therapy and endovascular therapy for intracranial atherosclerotic disease (ICAD) have evolved over the past two decades with improved medical therapy benchmarks, and improved techniques and patient selection for stenting. This study investigated patient co-morbidity trends to determine if these factors have led to better national patient outcomes.
Methods: We performed a data search from the U.S. National Inpatient Sample (NIS) database from 2009 to 2020, evaluating patients who presented with stroke from ICAD and were treated with angioplasty and stenting and analyzed presenting co-morbidities and patient outcomes. The sample included patients who presented with stroke due to severe stenosis and underwent elective stenting, and those who presented with large vessel occlusion (LVO) with underlying ICAD who underwent rescue stenting following thrombectomy. We analyzed Elixhauser co-morbidity groups to look for trends and looked at all-cause in-hospital mortality.
Results: Data from 2009 to 2020 showed no significant difference in patient mortality over the study period for patients who presented with LVO and underlying ICAD who underwent thrombectomy and rescue stenting, but there was a trend towards increased baseline co-morbidities. There was a significant decrease in mortality over the study period in patients who presented with stroke and severe stenosis who underwent elective angioplasty and stenting alone (p = 0.0103). Interestingly, there was a trend towards increased co-morbidities in patients during this period, despite the improved outcomes. There were significantly higher incidences in uncontrolled hypertension (28.2% vs 7.9%), diabetes (33.6% vs 4.6%), obesity (26.4% vs 10.2%) in the 2020 patient group compared to the 2009 patients. Hypercholesterolemia data is not captured in the Elixhauser co-morbidity analysis.
Conclusions: Despite SAMMPRIS aggressive medical therapy guidelines published in 2011, over the study period there was a trend towards worse co-morbidity profiles in both the thrombectomy plus stent and stent only cohorts. While there was no change in mortality in the thrombectomy plus stent group over time, there was a significant trend towards better outcomes with lower mortality in the stenting only cohort, suggesting improved outcomes with best practice techniques and better patient selection criteria for endovascular therapy