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

Abstract

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.