Abstract Details

Title Outcomes in Acute Ischemic Stroke Patients with Metastatic Cancer Undergoing Mechanical Endovascular Revascularization: Analysis of the National Readmission Database

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P14 - Poster Session 14 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-001

Objective Establish outcomes of mechanical thrombectomy for ischemic strokes in metastatic cancer.

Background Mechanical Thrombectomy (MT) became standard of care for ischemic stroke (IS) patients with large vessel occlusion presenting within 24 hours. However, patients with malignancy were excluded from major trials.

Design/Methods

This is a retrospective analysis of National Readmission Database between 2016-2018. Three groups were used for comparisons; 1.IS patients with metastatic cancer (MC) undergoing MT with or without thrombolytic therapy (TT). 2.IS patients with MC not undergoing MT who received or did not receive TT. 3.IS patients without MC undergoing MT with or without TT.

Multivariate regression was used to adjust for confounders and calculate adjusted odds ratio (aOR).

Results There was 933, 25731 and 38166 patients in each group, respectively. Mean age was 68.6, 69.6 and 68.5, respectively. Group-1 had higher stroke severity compared to other groups (95%, 54% and 93%; P<0.001), respectively. Multivariate logistic regression comparing group-1 to 2 showed that group-1 had higher in-hospital mortality (aOR=1.42 [95%CI 1.10-1.83]). More ICH was observed in group-1 (aOR=2.57 [95%CI; 1.81-3.65]) and longer length of stay (LOS) after excluding in-hospital deaths (aOR=1.44 [95%CI; (1.10-1.87)]. However, there was no difference in all-cause 90-day readmission. Compared to group-3, group-1 had higher in-hospital mortality (aOR=2.23, 95%CI [1.75-2.84]). However, no difference was observed in ICH, rehab transfer, all-cause 90-day readmission between the 2 groups.

Conclusions

Among MC patients, those receiving MT had more severe stroke, received more TT, had higher rates of ICH, rehab transfers, mortality, longer LOS and increased hospital costs of about $85,000. Compared to patients without MC, those with MC receiving MT had comparable stroke severity, LOS and complication rates, however had higher overall DRG severity and mortality. It remains unclear whether treatment of severe stroke in metastatic cancer patients with MT is superior to conservative treatment considering higher mortality in this group.

Authors/Disclosures
Hassan Aboul Nour, MD PRESENTER	Dr. Aboul Nour has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Daniel Miller, MD	Dr. Miller has nothing to disclose.
Stephan A. Mayer, MD (Henry Ford Hospital)	Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ceribell. Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Phagenesis. Dr. Mayer has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ISchemaView. Dr. Mayer has stock in Neuroptics. Dr. Mayer has received publishing royalties from a publication relating to health care.

��ɫ��

��ɫ��