Acute stroke reperfusion therapies for Down syndrome patients: Nationwide utilization rates and hospitalization outcomes.

Background: Down syndrome (DS) is a common chromosomal disorder, and life expectancy has drastically increased over the last several decades. While DS is known to be associated with an increased risk of acute ischemic stroke (AIS), the utilization rate and outcomes of intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT) for DS patients presenting with AIS are unknown.

Methods: This was a retrospective cohort study of the 2016-22 Nationwide Readmissions Database. Adult patients admitted for AIS were identified, and patients with DS were matched with non-DS controls using propensity score matching (PSM). Utilization rates of IVT and EVT were determined, as were hospitalization outcomes, including discharge to home and in-hospital death.

Results: 3435,097 stroke admissions were identified; after PSM 1161 DS patients and 2174 matched non-DS controls remained. DS patients were less likely to receive IVT (7.5 % vs. 19.4 %, p < 0.001) and EVT treatment (6.6 % vs. 12.2 %, p < 0.001), and DS patients also had a lower rate of discharge to home (61.6 % vs. 66.4 %, p < 0.001) and higher rate of mortality (6.4 % vs. 4.1 %, p = 0.027). Among non-DS patients, both IVT and EVT were associated with significantly higher odds of home discharge (adjusted OR 2.13 [95 %CI 1.23-3.67], p = 0.007 and 2.40 [95 %CI 1.21-4.79], p = 0.013, respectively); however, among DS patients, neither IVT nor EVT were associated with different odds of excellent outcomes (both p > 0.05).

Conclusions: Compared to matched controls, DS patients with AIS were less likely to receive IVT and EVT, had worse outcomes, and derived smaller clinical benefits from IVT and EVT.