Endovascular Thrombectomy after Large-Vessel Ischemic Stroke: Utilization, Outcomes, and Readmissions across the United States

Abstract

E ach year approximately 795 000 people experience a new or recurrent stroke, the fifth leading cause of death and the most common source of permanent disability in the United States. Ischemic stroke is responsible for 87% of all strokes (1). The first endovascular clot retrieval device was approved by the U.S. Food and Drug Administration in 2004, and endovascular treatment of patients with stroke evolved substantially during the next decade (2). In 2015, investigators in five multicenter randomized controlled clinical trials (3-7) reported a marked benefit for endovascular thrombectomy in the management of acute ischemic stroke (AIS) secondary to large-vessel occlusion. Shortly thereafter, the American Heart Association-American Stroke Association guidelines for management of AIS were revised to recommend endovascular thrombectomy in selected patients with proximal anterior circulation occlusion who presented within 6 hours from the time last known to be well (8). The impact of this landmark change in acute stroke management remains less studied at the population level. We therefore used the most recently available (2016-2017) National Inpatient Sample (NIS) and Nationwide Readmissions Database (NRD) data sets to examine realworld thrombectomy rates, adverse events, inpatient outcomes, and readmissions across the United States in the 2 years following large-scale adoption of thrombectomy in AIS. Materials and Methods Databases The NIS database and NRD contain all-payer data on hospital inpatient stays from states participating in the Healthcare Cost and Utilization Project (HCUP) sponsored by the Agency for Healthcare Research and Quality

Unplanned readmission after carotid stenting versus endarterectomy: analysis of the United States Nationwide Readmissions Database

“…Hospital size, teaching status, and city status were defined by the NRD. Reasons for readmissions were grouped as previously described 10…”

Coronavirus Disease 2019 Infection in Cervical Artery Dissections

“…Firstly, the database depends on the administrative data collection from discharge summaries and medical billing departments, which is prone to human error 14 . The ICD codes used in this study were obtained from previously validated studies, and the ICD-10 code used for COVID-19 diagnosis was established in April 2020 15–20 . In addition, the admissions captured in NIS are specific to inpatient settings, which may result in undercounting the true prevalence of COVID-19 among CeAD, especially those of milder cases.…”

“…14 The ICD codes used in this study were obtained from previously validated studies, and the ICD-10 code used for COVID-19 diagnosis was established in April 2020. [15][16][17][18][19][20] In addition, the admissions captured in NIS are specific to inpatient settings, which may result in undercounting the true prevalence of COVID-19 among CeAD, especially those of milder cases. Follow-up data in NIS are not available and, therefore, the recurrence of COVID or development of pseudoaneurysm could not identified.…”

Disparities in the Use of Mechanical Thrombectomy Alone Compared with Adjunctive Intravenous Thrombolysis in Acute Ischemic Stroke in the United States

“…Brinjikji et al indicated a significant reduction in the use of MT in uninsured patients compared with those with private insurance. 6 Golnari et al 15 investigated thrombectomy rates, outcomes, and readmission across the United States between 2016 and 2017 using the NIS and National Readmission Database (NRD) and compared the results with those of the HERMES collaboration meta-analysis. 16 Golnari et al also found a similar rate of nonroutine discharge to our cohort of NIS from 2013-2018 (78.2% versus 78.0% for all thrombectomies, respectively).…”

“…The HERMES collaboration helped shed light on the efficacy of thrombectomy for AIS, while the 3 recent clinical trials (DIRECT-MT, DEVT, and SKIP) contributed to the literature by investigating the efficacy of MT alone compared with MT1IV-tPA. 4,5,15,20 [21][22][23] These results may further increase the use of MT alone during the next several years. We hope that future studies will evaluate trends and disparities of use as more data from randomized controlled trials become available.…”