Abstract Details

Title Safety and Post-operative Complications of Endovascular Versus Surgical Versus Follow-up and Medical Treatment for Patients with Vertebrobasilar Artery Stenosis: Propensity Score Weighting and a Machine Learning Driven Analysis

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P12 - Poster Session 12 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-017

Objective NA

Background Vertebrobasilar artery stenosis (VBAS) can cause posterior circulation strokes (PCS). Optimal management is controversial, with options including medical therapy (MT), endovascular stenting (ES), and surgical revascularization (SR).

Design/Methods Patients with VBAS were identified from the 2017-2018 National Inpatient Sample (NIS) database. Propensity scores adjusted for baseline differences in patients undergoing no intervention (NI), ES, or SR. Outcomes included mortality, neurological complications (NC), discharge destination (DD), length of stay (LOS), total charges (TC), and procedural complications (PC). Predictive ability of clinical variables was assessed using logistic regression (LR) and machine learning techniques (MLT).

Results

Of 1,343 patients, 1,061 (79.0%) received NI, 234 (17.4%) underwent ES, and 24 (1.8%) had SR. Mean age was 69.45 years, with 64.1% male. Demographics: 69.8% White, 14.9% Black, 10.0% Hispanic, and 5.3% other races. Hypertension (HTN, 85.4%) and diabetes (DM, 18.9%) were prevalent. After propensity weighting, ES was associated with higher odds of mortality, surgical/medical complications (SMC), and device/graft complications (DGC) compared to NI. SR showed a non-significant trend toward higher non-home discharges (NHD). ES and SR groups had higher resource utilization with longer LOS and greater TC. Clinical variables alone were weak predictors, with AUC values ranging from 0.454 to 0.71 across different outcomes and models.

Conclusions ES of VBAS was associated with higher mortality and complication rates compared to MT alone, with inconsistent benefits for NC. SR also carried elevated risks without clear advantages over MT. These results support that current clinical variables from the NIS are weak predictors, highlighting the limitations of relying solely on clinical history. Future use of radiological and anatomical features can improve predictions and subgroup determination. Recent trials suggest the external vertebral artery may benefit from ES. More studies, including post hoc analyses, are needed to better inform treatment and patient selection, reinforcing the role of optimal MT.

Authors/Disclosures
Sai Varun Bethina, MBBS PRESENTER	Dr. Bethina has nothing to disclose.
Ahmed M. Shaheen	Dr. Shaheen has a non-compensated relationship as a A Research Position Candidate Under Trial Task with Solvemed Company that is relevant to AAN interests or activities.
Nour Shaheen, Sr., MBBS (Alexandria Faculty of Medicine)	Mr. Shaheen has nothing to disclose.
Ram K. Saha, MD (Virginia Commonwealth University)	Dr. Saha has nothing to disclose.

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