Introduction Cervical arterial dissections are important causes of ischemic stroke. However, the outcomes of carotid artery (CA) versus vertebral artery (VA) dissections have not been previously compared, nor has the impact of endovascular intervention been studied, on a nationwide level.
Methods Ischemic stroke admissions in the National Inpatient Sample (NIS) from 2016-2019 were retrospectively analyzed. Patient characteristics, presence and site of cervical arterial dissection, and outcomes were collected. Multivariable linear and logistic regression analyses adjusting for patient characteristics, endovascular and thrombolytic therapy, and complex sampling methodology were performed.
Results Of 536,540 patients with acute ischemic stroke (AIS) were identified, 5,351 (1%) had dissections; 2,789 (52%) with CA and 2,562 (48%) with VA dissection. CA dissection patients had significantly higher rates of concurrent traumatic brain injury (3.2% vs 1.5%; p<0.001) and were more likely to be treated with thrombolytic therapy (13% vs 6.6%; p<0.001), mechanical thrombectomy (19% vs 4.9%; p<0.001), or intraluminal stent placement (13% vs 2.2%; p<0.001). Multivariable analysis found that CA dissections were associated with greater odds of intracerebral/subarachnoid hemorrhage (OR=1.53; p<0.001) relative to VA dissections. Thrombolytic therapy (OR=1.34; p=0.053) and thrombectomy (OR=3.63; p<0.001) were associated with greater odds of intracerebral/subarachnoid hemorrhage. CA dissections were associated with longer length of stay (LOS; beta=1.7; p<0.001), charges (beta=34,115; p<0.001), and nonroutine discharge (OR=1.26; p<0.001). Thrombectomy was associated with greater LOS (beta=1.8; p=0.005), charges (beta=78,461; p<0.001), and odds of nonroutine discharge (OR=2.32; p<0.001). Diabetes (beta=0.85; p=0.023), chronic kidney disease (beta=1.8; p=0.036), and congestive heart failure (beta=2.7; p<0.001) were associated with longer LOS.
Conclusions Despite a similar prevalence among patients admitted for AIS, CA dissections are associated with a higher rate of endovascular intervention and poorer short-term outcomes compared to VA dissections. This study provides essential epidemiologic and outcome data for the cerebrovascular neurosurgeon.
Disclosures M. Brandel: None. C. McCann: None. A. Wali: None. V. Wu: None. S. Esmail: None. J. Steinberg: None. S. Olson: None. J. Pannell: None. A. Khalessi: None. D. Santiago-Dieppa: None.
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