National trends in endovascular therapy for acute ischemic stroke: utilization and outcomes

Abstract

ObjectiveFollowing widespread acceptance of endovascular therapy (ET) for large vessel occlusion stroke in 2015, we assessed nationwide utilization of revascularization for acute ischemic stroke (AIS).MethodsWe utilized the 2013–2016 Healthcare Cost and Utilization Project Nationwide Readmissions Database. We identified AIS admissions, treatment with intravenous thrombolysis (IVT), ET, and vascular risk factors using International Classification of Disease Clinical Modification codes. Main predictor of outcome was the time period of index admission (‘pre-endovascular era (pre-EA)’ January 2013–January 2015 and ‘endovascular era (EA)’ February 2015– December 2016). We calculated the proportion of AIS admissions in which, first, VT and second, ET was performed. Among patients treated with ET, we examined the association between era and discharge disposition, in-hospital mortality during index admission, and 30-day readmission.ResultsThere were 925 363 index AIS admissions before the EA and 857 347 during. A higher proportion of AIS patients received IVT (8.4% vs 7.8%) and ET (2.6% vs 1.3%) in the EA. Although length of stay (LOS) was shorter in the EA (5.70 vs 6.80 days), total charges were greater ($56 691 vs $53 878), and admissions were more often to a metropolitan hospital (65.2% vs 57.2%). Among those treated with ET, a smaller proportion received IVT (29.7% vs 44.9%), LOS was substantively shorter (9.75 vs 12.76 days), and patients had a lower odds of discharge home.ConclusionsThe utilization of ET has doubled in the EA but ET remains underutilized. ET is predominantly provided at metropolitan teaching hospitals and associated with higher charges despite shorter LOS and unchanged in-hospital mortality.

Mechanical thrombectomy reduces the gap in treatment outcomes of ischemic stroke between hospital levels of care: analysis of a Korean nationwide data

“…With the introduction of more effective treatment methods such as these, the number of patients with an expected favorable outcome may have increased regardless of the hospital they visited. The rate of a good outcome in this study was higher than a study using other insurance claims data but was slightly lower when compared to the ratio of patients with modified Rankin scale (mRS) 0-2 at three months (7,8,24). In this study, some patients who were not discharged home may have received treatments in a rehabilitation hospital and then recovered to mRS 0-2 at three months.…”

“…Therefore, an increase in the number of hospitals performing this procedure will likely result in an increased number of patients with a favorable prognosis. Indeed, previous studies reported improved prognoses in real-world clinical settings after the recent guideline changes (7,8).…”

National Trends in Clinical Outcomes of Endovascular Therapy for Ischemic Stroke in South Korea between 2008 and 2016

“…In agreement with other studies, 3,4 our analysis of the nationwide data showed that the patients treated with ET had better outcomes in the MT period than in the non-advanced MT period. Over time, the baseline prognostic characteristics, reflected by age and comorbidities, got worse; however, the outcomes of the patients generally improved; this was supported by the annual trend analyses (Supplementary Table 2).…”

“…The corresponding guidelines were revised in 2019 to broaden the scope of MT within 24 hours of symptom onset [ 2 ]. In previous studies, MT have improved the prognoses of patients in real-world clinical settings [ 3 , 4 ]. Using nationwide representative data, this study aimed to evaluate the national trends in clinical outcomes of patients treated with endovascular therapy (ET) in South Korea.…”

Trends in acute ischemic stroke treatments and mortality in the United States from 2012 to 2018

“…[6][7][8][9][10][11] Despite the proven efficacy of these treatments, IV tPA and MT remain severely underutilized. 12,13 To increase utilization of these therapies and standardize AIS care across the US, primary and comprehensive stroke centers (CSCs) were established as system-based strategies to improve outcomes. The first CSC certifications approved in 2012 required, among other things, high volumes, advanced imaging techniques, dedicated neurological intensive care units, and after-hospital care coordination for patients.…”