title: Outcomes of endovascular versus intravenous thrombolytic treatment for acute ischemic stroke in dialysis patients.
abstract: OBJECTIVE
  To compare the outcomes of IV thrombolytics (tissue plasminogen activator or tPA) with endovascular treatment (intra-arterial tPA ± mechanical thrombectomy) in dialysis patients who suffered from acute ischemic stroke.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Data analysis from Nationwide Inpatient Sample (NIS 2005- 2010) including dialysis patients presenting with acute ischemic stroke, either treated with IV thrombolytics or endovascular treatment.
  
  
  RESULTS
  Baseline characteristics, in-hospital complications, and discharge outcomes were compared between the two groups. We determined the effect of endovascular treatment on in-hospital mortality, disability at discharge, and post-thrombolytic intracerebral hemorrhages (ICH) after adjusting for potential confounders using multivariate analysis.
  
  
  RESULTS
  Of the 2 313 dialysis patients with ischemic stroke, 1 398 (60%) received IV thrombolytics and 915 (40%) were treated with endovascular treatment. The in-hospital mortality rate and moderate-to-severe disability were lower in dialysis patients receiving endovascular treatment (7.6% vs. 14.5% p = 0.04) and (30% vs. 52% p = <.0001), respectively. After adjusting for age, gender, and potential confounders, endovascular treatment was associated with lower in-hospital mortality (OR 0.5, 95% CI 0.2-0.9) and moderate-to-severe disability (OR 0.3, 95% CI 0.2-0.5).
  
  
  CONCLUSIONS
  The odds of both in-hospital mortality and moderate to severe disability were lower with endovascular treatment in dialysis patients. Such data support the preferential use of endovascular treatment in this patient population.
authors.affiliation: 1 Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio - USA.
authors.forename: Fahad
authors.initials: F
authors.lastname: Saeed
authors.forename: Malik M
authors.initials: MM
authors.lastname: Adil
authors.forename: Bilal Hussain
authors.initials: BH
authors.lastname: Piracha
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D007262:Infusions, Intravenous; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D006435:Renal Dialysis; D020521:Stroke / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator