LB005 Real-world outcomes of endovascular thrombectomy for treatment of acute basilar artery occlusion in the United States: results of the BArONIS study

Abstract

Introduction/Purpose Although previous evidence for treatment of acute basilar artery occlusion (BAO) had demonstrated clinical equipoise between endovascular thrombectomy (EVT) and medical management, recent clinical trial data have elucidated a clinical benefit to EVT in BAO patients for the first time. Methods and Methods Weighted discharge data from the National Inpatient Sample were queried to identify adult patients with acute BAO during the period of 2015 to 2019 treated with EVT or medical management only. Complex samples statistical methods and propensity-score adjustment using inverse probability of treatment weighting (IPTW) were performed to assess clinical endpoints. Results Among 3,950 BAO patients identified, 1,425 (36.1%) were treated with EVT (mean age 66.7 years, median NIHSS score 22). On unadjusted analysis, 155 (10.9%) EVT patients achieved favorable functional outcomes (discharge disposition to home without services), while 515 (36.1%) experienced inhospital mortality, and 20 (1.4%) developed symptomatic intracranial hemorrhage (sICH). Following propensity-score adjustment by IPTW accounting for age, acute neurological condition, and comorbidity burden, EVT was independently associated with favorable functional outcome [adjusted odds ratio (aOR) 1.25, 95% confidence interval (CI) 1.07, 1.46; p = 0.004], but not with in-hospital mortality or sICH. In an IPTW-adjusted sub-group analysis of patients with NIHSS scores > 20, EVT was associated with both favorable functional outcome (discharge disposition to home or to acute rehabilitation) (aOR 1.55, 95% CI 1.24, 1.94; p < 0.001) and decreased mortality (aOR 0.78, 95% CI 0.69, 0.89; p < 0.001), but not with sICH. Conclusions This population-based analysis using a large national registry demonstrates a clinical benefit of EVT in acute BAO patients, providing real-world confirmation of the findings of recently published clinical trial data.