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 patients with basilar artery occlusion (BAO) stroke is unclear. The purpose of this study is to investigate the safety and efficacy of EVT for elderly BAO stroke patients.

MATERIALS AND METHODS: This was an explorative retrospective analysis of the 2016–21 National Inpatient Sample in the United States. Elderly patients with BAO stroke (80 years of age or older) with an NIHSS score of at least 5 were included. Primary outcome was discharge home. Secondary outcomes included 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 confounders. Subgroup analyses were conducted for patients who did and did not receive IV thrombolysis (IVT).

RESULTS: We identified 2520 elderly patients with BAO stroke; 830 received EVT and 1690 received MM alone. After PSM, 1115 patients and 715 patients remained in the MM and EVT groups, respectively. Compared with PSM controls, EVT was not significantly associated with different rates of home discharge (17.5% versus 12.2%; OR, 1.36 [95% CI, 0.76–2.44], P = .30) or in-hospital mortality (31.5% versus 32.9%; OR, 1.00 [95% CI, 0.63–1.60], P = .99), but it was significantly associated with higher rates of ICH (18.2% versus 7.3%; OR, 2.69 [95% CI, 1.41–5.15], P = .003). Among patients who did not receive IVT, EVT was significantly associated with higher rates of home discharge (21.5% versus 11.5%; OR, 1.93 [95% CI, 1.02–3.66], P = .044), whereas EVT was not significantly associated with a different rate of home discharge among those treated with IVT (5.6% versus 15.0%; OR, 0.28 [95% CI, 0.05–1.46], P = .13). Interaction analysis revealed that IVT was a negative modulator of the positive association of EVTs with home discharge (interaction P = .031).

CONCLUSIONS: EVT was not significantly associated with more favorable hospitalization outcomes for elderly patients with BAO stroke, and it was significantly associated with an increased risk of ICH. EVT may be an effective treatment for patients who did not receive IVT.