Endovascular thrombectomy versus medical management for acute basilar artery occlusion stroke in the elderly

Background and purpose: The efficacy and safety of endovascular thrombectomy (EVT) for elderly basilar artery occlusion (BAO) stroke patients is unclear. Materials and methods: This was an explorative retrospective analysis of the 2016-21 National Inpatient Sample in the United States. Elderly BAO stroke patients (80 years or older) with NIH stroke scale of at least 5 were included. Primary outcome was discharge to home. Secondary outcomes include in-hospital mortality and intracranial hemorrhage (ICH). Outcomes were compared between patients treated with EVT and those treated with medical management (MM) alone. Propensity score matching (PSM) was performed to control for confounders. Subgroup analyses were conducted for patients who did and did not receive intravenous thrombolysis (IVT). Results: 2,520 elderly BAO patients were identified; 830 received EVT, and 1,690 received MM alone. After PSM, 1,115 patients and 715 patients remained in the MM and EVT groups, respectively. Compared to PSM controls, EVT was not significantly associated with different rates of home discharge (17.5% vs. 12.2%, OR 1.36 [95%CI 0.76-2.44], p=0.30) or in-hospital mortality (31.5% vs. 32.9%, OR 1.00 [95%CI 0.63-1.60], p=0.99), but it was significantly associated with higher rates of ICH (18.2% vs. 7.3%, OR 2.69 [95%CI 1.41- 5.15], p=0.003). Among patients who did not receive IVT, EVT was significantly associated with higher rates of home discharge (21.5% vs. 11.5%, OR 1.93 [95%CI 1.02-3.66], p=0.044), whereas EVT was not significantly associated with the same among those treated with IVT (5.6% vs. 15.0%, OR 0.28 [95%CI 0.05-1.46], p=0.13). Interaction analysis revealed that IVT was a negative modulator of EVT's positive association with home discharge (interaction p=0.031). Conclusions: EVT was not significantly associated with more favorable hospitalization outcomes for elderly BAO stroke patients, and it was significantly associated with increased risk of ICH. EVT may be an effective treatment for patients who did not receive IVT. Abbreviations: EVT = endovascular thrombectomy; BAO = basilar artery occlusion; ICH = intracranial hemorrhage; MM = medical management; PSM = propensity score matching; IVT = intravenous thrombolysis.