2025 Proffered Presentations
S374: INTRACRANIAL STENTING AND BYPASS HAVE SIMILAR NATIONWIDE OUTCOMES FOR TREATMENT OF INTRACRANIAL ATHEROSCLEROTIC DISEASE: A PROPENSITY-SCORE MATCHED ANALYSIS
Michael G Brandel, MD1; Alexander A Khalessi, MD1; Robert C Rennert, MD2; 1University of California, San Diego; 2University of Utah
Background: Management of symptomatic, medically refractory intracranial atherosclerotic disease (ICAD) may require neurosurgical intervention, including intracranial stenting or bypass. We herein compare the costs, complications, length of stay (LOS), and discharge disposition between these two treatment modalities for patients with ICAD.
Methods: Admissions from the National Inpatient Sample from 2012-2019 with a primary diagnosis of ICAD and procedures including intracranial stenting or bypass were retrospectively analyzed. Only elective cases performed on hospital admission day 0 were included. Patients with Moyamoya disease were excluded. Propensity score matching (PSM; 1:1) was performed to reduce potential sampling bias between ICAD patients who received stenting versus bypass. Analyses were performed using multilevel mixed effects generalized linear models (GLM) and logistic regression. Beta coefficients and odds ratios are reported, respectively.
Results: Overall, 556 admissions met study criteria. Mean age was 65.2 years. Most stent and bypass cases were performed in large-bed-sized hospitals: 74.0% and 65.9%, respectively. A larger proportion of bypass patients were female (47.3 vs. 37.5%, p=0.028) and had a Charlson comorbidity index of >=2 (77.2% vs. 61.5%, p<0.001), whereas a higher proportion of stent patients had a history of stroke (52.1% vs. 38.5%, p=0.002). Insurance type and income quartile did not differ between groups. PSM yielded an analysis subset of 330 patients, 165 who underwent stenting and 165 who underwent bypass (Table 1).
The cost of bypass admissions significantly exceeded stent admissions (B=0.17, p=0.024; mean cost $24,659 vs. $20,750). However, this difference disappeared when also adjusting for LOS. LOS was significantly longer for bypass (B=0.54, p<0.001; mean LOS 3.68 vs. 2.65 days). There were no significant differences in the odds of complications or adverse discharge (p>0.05).
Conclusion: For ICAD patients undergoing an elective intervention, bypass admissions are associated with an 17% increase in cost versus stenting, which is likely driven by a LOS increase of approximately one day. Although bypass is a more extensive and expensive intervention, with often slightly different indications, it has a comparable overall risk of complications and adverse discharge to intracranial stenting.