Utilization of endovascular thrombectomy in patients with antiphospholipid syndrome and acute ischemic stroke

Abstract Background Antiphospholipid syndrome (APS) is a prothrombotic state and can cause acute ischemic stroke (AIS) particularly in younger individuals. Purpose Given the recent widespread adoption of endovascular thrombectomy (EVT) in patients with AIS, we aimed to evaluate the current trends and utilization of this technique in patients with APS. Methods We used National Readmission Database (NRD) to identify patients admitted between 2016 and 2020 with a primary diagnosis of AIS and a concurrent diagnosis of APS using relevant ICD-10 CM codes. Results Our analysis identified a total of 2,535,777 patients admitted for AIS, of which 7209 had a concomitant diagnosis of APS. The median age in patients with APS was 55 compared to 71 in non-APS patients (p < 0.001). APS patients also exhibited a lower prevalence of comorbidities such as coronary artery disease (4% vs. 28%; p < 0.001), congestive heart failure (CHF) (15% vs. 19%; p < 0.001), atrial fibrillation (14% vs. 26%), and diabetes (12% vs. 18%; p < 0.001). Systemic lupus erythematosus (SLE) was the most prevalent concurrent autoimmune disease in the APS cohort (19%). Patients with APS were significantly more likely to undergo EVT compared to their non-APS counterparts (5.2% vs. 3.5%; p < 0.001). Mortality was higher in non-APS likely due to older age compared to non-APS but didn’t reach statistical significance (4.4% vs 3.7%, p=0.070). Notably, the length of hospital stay was significantly higher for patients with APS (median: 6 days) compared to the non-APS group (median: 3 days; p < 0.001). Furthermore, we observed a steady increase in the utilization of EVT in patients with APS and AIS from 2016 (3.7%) to 2020 (6.8%; p = 0.02). Conclusion Our findings demonstrate that patients with AIS and concurrent APS are more likely to undergo endovascular thrombectomy, potentially due to a higher stroke burden. Additionally, the study revealed a progressive increase in the use of EVT for this specific patient population.