Prevalence and prognosis of seizures among patients undergoing mechanical thrombectomy for acute ischemic stroke: A look at pre-2015 aha/asa guidelines update regarding endovascular treatment

Alain Lekoubou; Yael Pinero Colon; Kinfe G Bishu; Ajah T Ngonde; Leonardo Bonilha; Bruce Ovbiagele

doi:10.1016/j.jstrokecerebrovasdis.2023.107049

Prevalence and prognosis of seizures among patients undergoing mechanical thrombectomy for acute ischemic stroke: A look at pre-2015 aha/asa guidelines update regarding endovascular treatment

J Stroke Cerebrovasc Dis. 2023 May;32(5):107049. doi: 10.1016/j.jstrokecerebrovasdis.2023.107049. Epub 2023 Mar 17.

Authors

Alain Lekoubou¹, Yael Pinero Colon², Kinfe G Bishu³, Ajah T Ngonde⁴, Leonardo Bonilha⁵, Bruce Ovbiagele⁶

Affiliations

¹ Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA; Department of Public Health Sciences, Penn State University, Hershey, PA, USA. Electronic address: alekouboulooti@pennstatehealth.psu.edu.
² Department of Neurology, Penn State University, Hershey Medical Center, Hershey, PA, USA.
³ Department of Medicine, Medical University of South Carolina, Charleston, SC, USA; Health Equity and Rural Outreach Innovation Center (HEROIC), Ralph H. Johnson VA Medical Center, Charleston, SC, USA.
⁴ Faculty of Medicine and Biomedical Sciences, University of Yaounde, Yaounde, Cameroon.
⁵ Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
⁶ Department of Neurology, University of California, San Francisco, CA, USA.

PMID: 36934518
DOI: 10.1016/j.jstrokecerebrovasdis.2023.107049

Abstract

Background: Mechanical Thrombectomy (MT) is standard of care for eligible patients with Acute Ischemic Stroke (AIS) due to large vessel occlusion (LVO). With increasing use of MT, clinicians are more likely to encounter seizures, a potential complication of AIS treated with MT. Tracking future trends in the burden of post-stroke seizure associated with MT will require baseline pre-approval benchmark estimates of its frequency and outcomes.

Methods: All patients with AIS who underwent MT (International Classification of Diseases, Ninth Revision, Clinical Modification; ICD-9-CM procedure code: 39.74) were identified from the National Inpatient Sample (NIS) 2006-2014, using appropriate ICD-9-CM codes. We identified a subset of patients with seizures using ICD-9-CM secondary discharge diagnoses codes 780.3x and 345.x. We computed the rate of seizures overall and across pre-specified demographic, clinical, and healthcare system-related variables. Finally, we assessed the independent association of mortality with seizures using a multivariable logistic regression model.

Results: Of 30137 (weighted) patients with AIS who underwent MT, 1,363 (4.5%) had seizures. Patients who had seizures were younger, privately insured, or Medicaid beneficiaries, and frequently died in the hospital. There were no statistically significant differences between the seizures and no-seizures groups by race, sex, IV thrombolysis with recombinant tissue plasminogen activator, length of stay, and the number of medical comorbidities. However, patients who underwent MT and developed seizures had 75% higher odds of in-hospital mortality (adjusted OR 95% CI 1.75; 1.22-2.49).

Conclusion: In this nationwide sample, prior to the 2015 AHA/ASA guidelines update supporting MT use, seizures occurred in one of twenty patients with AIS treated with MT, and occurrence of seizure was independently associated with a nearly two-fold increase in the odds of in-hospitality death.

Keywords: Ischemic stroke; Outcomes; Seizures; Thrombectomy.

MeSH terms

Brain Ischemia* / complications
Brain Ischemia* / diagnosis
Brain Ischemia* / therapy
Humans
Ischemic Stroke* / etiology
Prevalence
Prognosis
Retrospective Studies
Thrombectomy
Tissue Plasminogen Activator / adverse effects
Treatment Outcome

Substances

Tissue Plasminogen Activator