NYMC Faculty Publications

Acute Ischemic Strokes in Patients With Developmental Disabilities: A Cross-Sectional Analysis

Authors

Aiden Lui, School of Medicine, New York Medical College, Valhalla, NY, USA.
Eric Feldstein, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Kevin Clare, School of Medicine, New York Medical College, Valhalla, NY, USA.
Alis J. Dicpinigaitis, School of Medicine, New York Medical College, Valhalla, NY, USA.
Medha Reddy, School of Medicine, New York Medical College, Valhalla, NY, USA.
Farzana Khan, School of Medicine, New York Medical College, Valhalla, NY, USA.
Rosa Semaan, School of Medicine, New York Medical College, Valhalla, NY, USA.
Daniela Galluzzo, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Steve Shapiro, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Haris Kamal, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Shadi Yaghi, Department of Neurology, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA.
Jared Pisapia, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.Follow
Carrie Muh, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY 10595, United States.Follow
Rolla Nuoman, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Philip Overby, New York Medical CollegeFollow
Mill Etienne, School of Medicine, New York Medical College, Valhalla, NY, USA.
Ji Chong, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Stephan Mayer, Department of Neurology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Chirag D. Gandhi, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.
Fawaz Al-Mufti, Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA.Follow

Author Type(s)

Faculty, Resident/Fellow, Student

DOI

10.1177/15910199221110327

Journal Title

Interventional Neuroradiology

First Page

555

Last Page

560

Document Type

Article

Publication Date

10-1-2023

Department

Neurosurgery

Second Department

Pediatrics

Third Department

Neurology

Abstract

OBJECTIVE: Patients with developmental disabilities (DD) are frequently excluded from acute ischemic stroke (AIS) randomized control trials. We sought to evaluate the impact of having DD on this patient cohort. METHODS: The National Inpatient Sample was analyzed to explore the impact of AIS and treatment on discharge dispositions in patients with DD. Clinical characteristics, treatments, and outcomes were compared to fully-abled patients with AIS. RESULTS: 1,605,723 patients with AIS were identified from 2010-2019, of whom 4094 (0.30%) had a DD. AIS patients with DD were younger (60.31 vs 70.93 years, p < 0.01), less likely to be Caucasian (66.37%vs 68.09%, p = 0.01), and had higher AIS severity (0.63 vs 0.58, p < 0.01). Tissue plasminogen activator (tPA) was administered in 99,739 (6.2%) fully-abled patients and 196 (4.79%) of patients with DD (p < 0.01). Endovascular thrombectomy (EVT) was performed in 21,066 (1.31%) of fully-abled patients and 35 (0.85%) of patients with DD (p < 0.01). The presence of developmental disabilities were predictive of lower rates of tPA (OR:0.71,CI:0.56-0.87,p < 0.01) and EVT (OR:0.24,CI:0.16-0.36,p < 0.01). In a propensity score-matched cohort of all AIS patients who underwent EVT, there was no difference in functional outcome (p = 0.41), in-hospital mortality (0.10), and LOS (p = 0.79). CONCLUSION: AIS patients with DD were less likely to receive tPA and EVT compared to fully-abled patients. Individuals with DD had higher mortality and worse discharge disposition. There was no significant difference in post-EVT outcomes between fully-abled patients and patients with developmental disabilities. In the absence of prospective clinical trials, population based cross-sectional analyses such as the present study provide valuable clinical insight.

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