Abstract Details

Title Outside Hospital Transfer Significantly Influences Clinical Outcomes in Octogenarians Undergoing Endovascular Thrombectomy for Vertebrobasilar Artery Occlusions

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P9 - Poster Session 9 (11:45 AM-12:45 PM)

Poster/Presentation
Number 13-001

Objective

To assess the impact of age (<80 vs. ≥80 years) and presenting site (hub vs. spoke) on clinical outcomes in patients undergoing endovascular thrombectomy (EVT) for vertebrobasilar artery occlusions (VBAOs).

Background

EVT is the standard treatment for acute ischemic stroke caused by large vessel occlusions. This study investigates how age and the site of presentation influence outcomes in VBAO patients treated within hub-and-spoke networks.

Design/Methods A retrospective analysis was conducted on patients with VBAOs treated with EVT at a comprehensive stroke center. Patients were categorized into two age groups (<80 years and ≥80 years) and by presenting site (Hub vs. Spoke). Primary outcomes included modified Rankin Scale (mRS ≤3) at 90 days and mortality. Interaction effects were evaluated using logistic regression.

Results A total of 175 patients were included, with 48 (27.4%) in the Hub group and 127 (72.6%) in the Spoke group. Among these, 37 (21.1%) were aged ≥80 years. For patients <80 years, mRS ≤3 at 90 days was observed in 52.27% (46/88) of the Hub group and 39.47% (15/38) of the Spoke group (p=0.187). In octogenarians (≥80 years), mRS ≤3 was 50.00% (4/8) in the Hub group and 19.23% (5/26) in the Spoke group, with a significant interaction (p-value for interaction =0.02). Mortality at 90 days was 36.36% in patients <80 years in the Hub group vs. 50.00% in the Spoke group, whereas for octogenarians, mortality was 50.00% (Hub) vs. 73.08% (Spoke), (p-value for interaction =0.074).

Conclusions Octogenarians with acute VBAOs treated with EVT who presented directly to the hub experienced significantly improved outcomes compared to those first presenting to a spoke hospital. These findings suggest that older patients with VBAO stroke may have reduced tolerance to outside transfers for EVT. Further research is needed to validate these results and prioritize transfer protocols for older populations undergoing EVT for VBAOs.

Authors/Disclosures
Lucas Rios Rocha, MD (UPMC) PRESENTER	Dr. Rios Rocha has nothing to disclose.
Mohamed Fahmy Doheim (University of Pittsburgh)	Mr. Doheim has nothing to disclose.
Alhamza Al-Bayati, MD (UPMC Stroke Institute)	Dr. Al-Bayati has nothing to disclose.
Abdullah M. Al-Qudah, MD (University of Pittsburgh Medical Center)	Dr. Al-Qudah has nothing to disclose.
Nirav Bhatt, MD (University of Pittsburgh)	Dr. Bhatt has nothing to disclose.
Matthew T. Starr, MD (University of Pittsburgh Medical Center)	Dr. Starr has nothing to disclose.
Anmol Almast	Miss Almast has nothing to disclose.
Jussie Correia Lima, MD	Dr. Correia Lima has nothing to disclose.
Michael Lang, MD	Dr. Lang has nothing to disclose.
Bradley Gross, MD	Dr. Gross has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Gross has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Microvention. Dr. Gross has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA.
Raul G. Nogueira, MD (UPMC Stroke Institute)	Dr. Nogueira has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron (consulting fees) as well as for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse and Perfuze ( stock options). Dr. Nogueira has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Law Firms. Dr. Nogueira has received stock or an ownership interest from Viz-AI, Perfuze, Cerebrotech, Reist/Q'Apel Medical, Truvic, and Viseon. The institution of Dr. Nogueira has received research support from Cerenovus.
Marcelo Rocha, MD, PhD (UPMC)	The institution of Dr. Rocha has received research support from NIH.

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