Short-Term Prognosis After Endovascular Thrombectomy in Patients With Brain Tumors: A Nationwide Analysis

The utilization and outcomes of endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) in the presence of brain tumors has not been studied. Using the National Inpatient Sample (NIS), we performed a retrospective analysis of the rate of utilization of EVT in patients with AIS and brain tumors and their odds of in-hospital mortality and home discharge.

All adult (≥18 years) AIS patients with brain tumors of malignant, benign, or undetermined subtypes, and EVT use were identified in the NIS (2016-2019). Outcomes were odds of home discharge and in-hospital mortality, adjusted for age, sex, race, income, insurance, hospital size, intravenous tissue plasminogen activator (IV-tPA) use, and clinical severity of hospital admission.

Of 533,351 AIS patients, 7070 (1.3%) had brain tumors. Sixty-two percent were malignant, 33% benign, and 5.2% undetermined. Patients with brain tumors less frequently received IV-tPA (3.4% vs 10.3%) and EVT (1.9% vs 3.6%) (P < 0.001). Home discharge after EVT was similar in patients with vs without brain tumors, for all tumor subtypes (28.0% vs 28.4%, P = 0.933). In-hospital mortality was higher with brain tumors (22.6% vs 13.0%, P < 0.001), but largely driven by malignant subtype. In adjusted analysis, only patients with malignant tumors experienced greater in-hospital death after EVT (aOR: 2.78, 95% CI: 1.61-4.80).

Patients with malignant brain tumors may have higher in-hospital mortality after EVT but similar rate of home discharge. These results are limited by lack of information on confounders such as brain tumor characteristics and causes of mortality in the NIS.