Outcomes of endovascular versus intravenous thrombolytic treatment for acute ischemic stroke in dialysis patients.

BACKGROUND AND OBJECTIVES

To compare the outcomes of IV thrombolytics (tissue plasminogen activator or tPA) with endovascular treatment (intra-arterial tPA ± mechanical thrombectomy) in dialysis patients who suffered from acute ischemic stroke.

STUDY DESIGN

Observational study.

SETTING AND PARTICIPANTS

Data analysis from Nationwide Inpatient Sample (NIS 2005- 2010) including dialysis patients presenting with acute ischemic stroke, either treated with IV thrombolytics or endovascular treatment.

OUTCOMES

Baseline characteristics, in-hospital complications, and discharge outcomes were compared between the two groups. We determined the effect of endovascular treatment on in-hospital mortality, disability at discharge, and post-thrombolytic intracerebral hemorrhages (ICH) after adjusting for potential confounders using multivariate analysis.

RESULTS

Of the 2 313 dialysis patients with ischemic stroke, 1 398 (60%) received IV thrombolytics and 915 (40%) were treated with endovascular treatment. The in-hospital mortality rate and moderate-to-severe disability were lower in dialysis patients receiving endovascular treatment (7.6% vs. 14.5% p = 0.04) and (30% vs. 52% p = <.0001), respectively. After adjusting for age, gender, and potential confounders, endovascular treatment was associated with lower in-hospital mortality (OR 0.5, 95% CI 0.2-0.9) and moderate-to-severe disability (OR 0.3, 95% CI 0.2-0.5).

CONCLUSIONS

The odds of both in-hospital mortality and moderate to severe disability were lower with endovascular treatment in dialysis patients. Such data support the preferential use of endovascular treatment in this patient population.