Abstract Details

Title Rates and Outcomes of Neurosurgical Intervention for Thromboytic-Related Intracerebral Hemorrhage in Patients with Acute Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P01 - (-)

Poster/Presentation
Number 221

Objective

Background BACKGROUND: Post-thrombolytic intracerebral hemorrhage (ICH) is an infrequent occurrence in patients with acute ischemic stroke. Controversy surrounds the value of neurosurgical intervention in these patients and whether such availability is a necessary prerequisite for administration of thrombolytics.

Design/Methods DESIGN/METHODS: Using the Nationwide Inpatient Sample from 2002 to 2010, acute ischemic stroke patients who suffered from post-thrombolytic ICH were identified using ICD-9 codes. Patients were divided into those who received craniotomy and those who received medical management alone. Discharge destination and mortality were primary endpoints.

Results RESULTS: An estimated 7607 patients suffered post-thrombolytic ICH; 125 (1.6%) of those patients underwent craniotomy and 7482 patients (98.4%) received medical management alone. Patients in the craniotomy group were younger (53.7±36 versus 72.4±29 years, p=0.09) and were frequently in the extreme severity APR-DRG category compared with the medical management group (92.2% versus 55.5%, p=0.001). The mean length of stay was longer in the craniotomy group (21.5 versus 10 days, p<0.0001). After adjusting for age, gender and APR-DRG severity, the odds ratios of in-hospital mortality, discharge to extended care facility and discharge to home/self-care were 0.8 (95%CI 0.3-2.0, p=0.5), 5.4 (95%CI 0.6-52.0, p=0.1) and 0.2 (95%CI 0.02-1.8, p=0.1), respectively for craniotomy group compared with medical management group.

Conclusions CONCLUSIONS: Craniotomy for post-thrombolytic ICH in acute stroke is a salvage treatment offered to a small proportion of patients. In current practice, most patients undergoing craniotomy either die or are discharged to a long-term care facility.

Authors/Disclosures
PRESENTER	No disclosure on file
	No disclosure on file
Perry Shieh, MD, PhD, FAAN (UCLA)	Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sarepta. Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Genentech. Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion. Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Argenx. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for UCB. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for CSL Behring. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Grifols. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion. Dr. Shieh has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Biogen. Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Shieh has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Argenx. Dr. Shieh has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Catalyst.
Haseeb A. Rahman, MD (Houston Methodist)	Dr. Rahman has nothing to disclose.
Farhan Siddiq, MD	Dr. Siddiq has nothing to disclose.
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.

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