Frequency and Timing of Endovascular Therapy in Acute Stroke Patients: A Population-Based Analysis Using the Bremen Stroke Register

Abstract

<b><i>Background and Purpose:</i></b> In patients with large vessel occlusions (LVOs), endovascular treatment (ET) has become the standard of care, so that the potential number of these patients needs to be considered for the effective implementation of comprehensive stroke services. However, population-based data on the incidence of ET are scarce. <b><i>Methods:</i></b> Using our prospective stroke register, in which all endovascular procedures on the 557,464 inhabitants of the city of Bremen are included, we performed a population-based analysis on the frequency and timing of ET in acute stroke patients with LVOs in the year 2017. <b><i>Results:</i></b> Out of a total of 1,448 acute ischemic stroke patients, 173 patients (12%) had received ET (161 patients in the anterior circulation and 12 patients in the posterior circulation). Among these, 95 patients were inhabitants of Bremen. The population-based incidence thus was 17 (95% confidence interval [CI]: 14–21) ET cases per 100,000 person-years. The number of stroke procedures per month varied from 9 to 19 (median: 14.5; interquartile range [IQR]: 12–17). The number of stroke procedures per month and 100,000 inhabitants varied from 0.7 to 2.1 (median: 1.4; IQR: 0.9–1.7). Many procedures (53%) were performed during nonwork hours (between 17:00 h and 06:59 h or weekends). <b><i>Conclusions:</i></b> Approximately 12% of all ischemic stroke patients received ET, and the incidence of ET was 17 (95% CI: 14–21) cases per 100,000 person-years. However, despite being a high-volume center, the absolute number of stroke procedures per month was low, and many patients were treated during nonwork hours.