Propensity score matched analysis of nationwide outcomes for intracranial bypass and stenting for treatment of intracranial atherosclerotic disease

Management options for refractory intracranial atherosclerotic disease (ICAD) involve intracranial stenting or bypass. By retrospectively analyzing National Inpatient Sample database data (2012-2019), we compared costs, complications, length of stay (LOS), and discharge disposition of patients who underwent elective intracranial stenting or bypass for ICAD. Analyses included propensity score matching (PSM; 1:1), multilevel mixed-effects generalized linear models, and logistic regression. Overall, 556 admissions were included (mean age 65.2 years). Patients undergoing bypass were more likely than stenting patients to be female (47.3% vs. 37.5%, p = 0.028) and to have a Charlson Comorbidity Index score ≥ 2 (77.2% vs. 61.5%, p < 0.001) but less likely to have a history of transient ischemic attack/stroke (52.2 vs. 62.0%, p = 0.027). PSM yielded a subset of 330 patients (165 stenting, 165 bypass). The unadjusted cost of bypass admissions exceeded that of stent admissions (mean $24,659 vs. $20,750, p = 0.056), driven by significantly longer LOS for bypass (B = 1.69, p < 0.001). There were no significant differences in the odds of complications or adverse discharge by treatment (p > 0.05). These data suggest that for patients with ICAD undergoing an elective intervention, bypass and stenting have largely comparable overall costs and short-term outcomes. Treatment for refractory ICAD should be individualized based on patient and clinical criteria.