Abstract DP378: Endovascular Thrombectomy versus Medical Management in Patients with Dementia and Acute Ischemic Stroke

Background and Objectives: Endovascular thrombectomy (EVT) is effective for select patients with large vessel occlusion (LVO) stroke. While baseline dementia is a known negative predictor for good post-EVT outcomes, comparative efficacy and safety data of EVT versus best medical management (BMM) for LVO patients with dementia is limited. Herein, we compared hospitalization outcomes of EVT versus BMM for LVO patients with underlying dementia. Methods: Using the Nationwide Readmissions Database from 2016-2022, we identified adult patients with dementia who presented with acute ischemic stroke due to LVO. The primary outcome was discharge to home (as opposed to a rehabilitation or nursing home facility). Secondary outcomes included in-hospital mortality, length of stay, and complications. Patients who underwent EVT were compared to those who received BMM, after propensity score matching (PSM) to adjust for confounders. Interaction and subgroup analyses assessed treatment effect heterogeneity associated with age and dementia type. Results: Among 37,298 patients included, 6,622 (17.8%) received EVT. After PSM, 6,551 EVT and 13,029 BMM patients remained. Discharge to home rates were similar between groups (27.0% vs 26.1%, p=0.41). EVT was associated with longer length of stay (median 7 vs 5 days, p<0.001) and increased intracranial hemorrhage (23.9% vs 11.4%, p<0.001), with no significant difference in mortality (15.1% vs. 14.9%, p=0.79). Patient age significantly moderated EVT effectiveness (interaction p=0.001), and EVT among patients <75 years old was significantly associated with higher rates of home discharge (36.4% vs 29.3%, p=0.003). Additionally, EVT appeared more effective for patients with vascular dementia (as compared to Alzheimer’s disease, interaction p=0.016), among whom EVT was associated with significantly higher rates of home discharge (32.7% vs. 25.2%, p=0.008) Conclusion: Clinical response to EVT treatment is heterogeneous among LVO stroke patients with underlying dementia. Younger patients (<75 years old) and those with vascular dementia significantly benefited from treatment. Thus, dementia alone should not be protocolized as a general exclusion criteria for EVT, and future studies are needed to further refine patient selection strategies.