Outcomes of endovascular mechanical thrombectomy and intravenous tissue plasminogen activator for the treatment of vertebrobasilar stroke

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Abstract

Background and PurposezzAggressive treatment of posterior-circulation occlusions is important due to the high rates of morbidity and mortality associated with these infarctions. A large administrative database was evaluated to determine the outcomes of mechanical thrombectomy and intravenous tissue plasminogen activator (IV-tPA) for the treatment of posteriorcirculation (vertebrobasilar) strokes. Outcomes were compared across age groups. MethodszzThe United States Nationwide Inpatient Sample was used to evaluate the outcomes of patients treated for posterior-circulation acute ischemic stroke between 2006 and 2010. Patients who underwent endovascular mechanical thrombectomy and IV-tPA were selected. Primary outcomes were discharge status and mortality; secondary outcomes were length of stay, rate of intracranial hemorrhage, tracheostomy, and percutaneous endoscopic gastrostomy/jejunostomy tube placement. Outcomes were grouped according to age (i.e., <50, 50-64, and ≥65 years). Chi-squared test and Student's t-test were used for comparisons of categorical and continuous variables, respectively. ResultszzDuring 2006-2010 there were 36,675 patients who had discharge International Classification of Diseases (9th edition) codes indicating posterior-circulation strokes. Of these, 631 (1.7%) underwent mechanical thrombectomy and 1554 (4.2%) underwent IV-tPA. The in-hospital mortality rate for mechanical thrombectomy patients was significantly lower for those aged <50 years than for those aged 50-64 years (30.4% versus 47.4%, p<0.01) and those aged ≥65 years (30.4% versus 43.0%, p≤0.01). Age had no effect on the in-hospital mortality for IVtPA patients, with an incidence of 22.7% for patients aged <50 years, compared to 25.4% for patients aged 50-64 years (p=0.46) and 23.0% for patients aged ≥65 years (p=0.92). ConclusionszzPatients requiring IV-tPA and/or mechanical thrombectomy for the treatment of posterior-circulation strokes suffer from high mortality rates. Increased age is associated with significantly higher mortality rates among posterior-circulation stroke patients who require mechanical thrombectomy.

Original languageEnglish (US)
Pages (from-to)17-23
Number of pages7
JournalJournal of Clinical Neurology (Korea)
Volume10
Issue number1
DOIs
StatePublished - Jan 1 2014

Fingerprint

Thrombectomy
Tissue Plasminogen Activator
Stroke
Mortality
Therapeutics
Hospital Mortality
Jejunostomy
Gastrostomy
Intracranial Hemorrhages
Tracheostomy
International Classification of Diseases
Infarction
Inpatients
Length of Stay
Age Groups
Databases
Students
Morbidity

Keywords

  • Brain infarction
  • Endovascular techniques
  • Posterior circulation
  • Stroke
  • Tissue-type plasminogen activator

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

@article{204a7ac19ead470f8dd7ab52e03b56ae,
title = "Outcomes of endovascular mechanical thrombectomy and intravenous tissue plasminogen activator for the treatment of vertebrobasilar stroke",
abstract = "Background and PurposezzAggressive treatment of posterior-circulation occlusions is important due to the high rates of morbidity and mortality associated with these infarctions. A large administrative database was evaluated to determine the outcomes of mechanical thrombectomy and intravenous tissue plasminogen activator (IV-tPA) for the treatment of posteriorcirculation (vertebrobasilar) strokes. Outcomes were compared across age groups. MethodszzThe United States Nationwide Inpatient Sample was used to evaluate the outcomes of patients treated for posterior-circulation acute ischemic stroke between 2006 and 2010. Patients who underwent endovascular mechanical thrombectomy and IV-tPA were selected. Primary outcomes were discharge status and mortality; secondary outcomes were length of stay, rate of intracranial hemorrhage, tracheostomy, and percutaneous endoscopic gastrostomy/jejunostomy tube placement. Outcomes were grouped according to age (i.e., <50, 50-64, and ≥65 years). Chi-squared test and Student's t-test were used for comparisons of categorical and continuous variables, respectively. ResultszzDuring 2006-2010 there were 36,675 patients who had discharge International Classification of Diseases (9th edition) codes indicating posterior-circulation strokes. Of these, 631 (1.7{\%}) underwent mechanical thrombectomy and 1554 (4.2{\%}) underwent IV-tPA. The in-hospital mortality rate for mechanical thrombectomy patients was significantly lower for those aged <50 years than for those aged 50-64 years (30.4{\%} versus 47.4{\%}, p<0.01) and those aged ≥65 years (30.4{\%} versus 43.0{\%}, p≤0.01). Age had no effect on the in-hospital mortality for IVtPA patients, with an incidence of 22.7{\%} for patients aged <50 years, compared to 25.4{\%} for patients aged 50-64 years (p=0.46) and 23.0{\%} for patients aged ≥65 years (p=0.92). ConclusionszzPatients requiring IV-tPA and/or mechanical thrombectomy for the treatment of posterior-circulation strokes suffer from high mortality rates. Increased age is associated with significantly higher mortality rates among posterior-circulation stroke patients who require mechanical thrombectomy.",
keywords = "Brain infarction, Endovascular techniques, Posterior circulation, Stroke, Tissue-type plasminogen activator",
author = "Waleed Brinjikji and Alejandro Rabinstein and Cloft, {Harry J.}",
year = "2014",
month = "1",
day = "1",
doi = "10.3988/jcn.2014.10.1.17",
language = "English (US)",
volume = "10",
pages = "17--23",
journal = "Journal of Clinical Neurology (Korea)",
issn = "1738-6586",
publisher = "Korean Neurological Association",
number = "1",

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TY - JOUR

T1 - Outcomes of endovascular mechanical thrombectomy and intravenous tissue plasminogen activator for the treatment of vertebrobasilar stroke

AU - Brinjikji, Waleed

AU - Rabinstein, Alejandro

AU - Cloft, Harry J.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background and PurposezzAggressive treatment of posterior-circulation occlusions is important due to the high rates of morbidity and mortality associated with these infarctions. A large administrative database was evaluated to determine the outcomes of mechanical thrombectomy and intravenous tissue plasminogen activator (IV-tPA) for the treatment of posteriorcirculation (vertebrobasilar) strokes. Outcomes were compared across age groups. MethodszzThe United States Nationwide Inpatient Sample was used to evaluate the outcomes of patients treated for posterior-circulation acute ischemic stroke between 2006 and 2010. Patients who underwent endovascular mechanical thrombectomy and IV-tPA were selected. Primary outcomes were discharge status and mortality; secondary outcomes were length of stay, rate of intracranial hemorrhage, tracheostomy, and percutaneous endoscopic gastrostomy/jejunostomy tube placement. Outcomes were grouped according to age (i.e., <50, 50-64, and ≥65 years). Chi-squared test and Student's t-test were used for comparisons of categorical and continuous variables, respectively. ResultszzDuring 2006-2010 there were 36,675 patients who had discharge International Classification of Diseases (9th edition) codes indicating posterior-circulation strokes. Of these, 631 (1.7%) underwent mechanical thrombectomy and 1554 (4.2%) underwent IV-tPA. The in-hospital mortality rate for mechanical thrombectomy patients was significantly lower for those aged <50 years than for those aged 50-64 years (30.4% versus 47.4%, p<0.01) and those aged ≥65 years (30.4% versus 43.0%, p≤0.01). Age had no effect on the in-hospital mortality for IVtPA patients, with an incidence of 22.7% for patients aged <50 years, compared to 25.4% for patients aged 50-64 years (p=0.46) and 23.0% for patients aged ≥65 years (p=0.92). ConclusionszzPatients requiring IV-tPA and/or mechanical thrombectomy for the treatment of posterior-circulation strokes suffer from high mortality rates. Increased age is associated with significantly higher mortality rates among posterior-circulation stroke patients who require mechanical thrombectomy.

AB - Background and PurposezzAggressive treatment of posterior-circulation occlusions is important due to the high rates of morbidity and mortality associated with these infarctions. A large administrative database was evaluated to determine the outcomes of mechanical thrombectomy and intravenous tissue plasminogen activator (IV-tPA) for the treatment of posteriorcirculation (vertebrobasilar) strokes. Outcomes were compared across age groups. MethodszzThe United States Nationwide Inpatient Sample was used to evaluate the outcomes of patients treated for posterior-circulation acute ischemic stroke between 2006 and 2010. Patients who underwent endovascular mechanical thrombectomy and IV-tPA were selected. Primary outcomes were discharge status and mortality; secondary outcomes were length of stay, rate of intracranial hemorrhage, tracheostomy, and percutaneous endoscopic gastrostomy/jejunostomy tube placement. Outcomes were grouped according to age (i.e., <50, 50-64, and ≥65 years). Chi-squared test and Student's t-test were used for comparisons of categorical and continuous variables, respectively. ResultszzDuring 2006-2010 there were 36,675 patients who had discharge International Classification of Diseases (9th edition) codes indicating posterior-circulation strokes. Of these, 631 (1.7%) underwent mechanical thrombectomy and 1554 (4.2%) underwent IV-tPA. The in-hospital mortality rate for mechanical thrombectomy patients was significantly lower for those aged <50 years than for those aged 50-64 years (30.4% versus 47.4%, p<0.01) and those aged ≥65 years (30.4% versus 43.0%, p≤0.01). Age had no effect on the in-hospital mortality for IVtPA patients, with an incidence of 22.7% for patients aged <50 years, compared to 25.4% for patients aged 50-64 years (p=0.46) and 23.0% for patients aged ≥65 years (p=0.92). ConclusionszzPatients requiring IV-tPA and/or mechanical thrombectomy for the treatment of posterior-circulation strokes suffer from high mortality rates. Increased age is associated with significantly higher mortality rates among posterior-circulation stroke patients who require mechanical thrombectomy.

KW - Brain infarction

KW - Endovascular techniques

KW - Posterior circulation

KW - Stroke

KW - Tissue-type plasminogen activator

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DO - 10.3988/jcn.2014.10.1.17

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