Trends in mortality following mechanical thrombectomy for the treatment of acute ischemic stroke in the USA

Villwock, Mark R.; Padalino, David J.; Deshaies, Eric M.

doi:10.1136/neurintsurg-2015-011674

Cited by 13 publications

(9 citation statements)

References 29 publications

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“…This number is similar to the reports of previous large vessel occlusion studies. 28 It should be noted that the majority of deaths in our study occurred in patients who were at least 80 years old and mostly with pre-existing conditions. Since it is known that octogenarians are at greater risk of mortality, 29 the safety profile of the Tigertriever 13 device may be higher in younger patients.…”

Section: Discussionmentioning

confidence: 73%

Effectiveness of very low profile thrombectomy device in primary distal medium vessel occlusion, as rescue therapy after incomplete proximal recanalization or following iatrogenic thromboembolic events

Rikhtegar

Mosimann

Weber

et al. 2021

J NeuroIntervent Surg

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BackgroundRecent progress with smaller retrievers has expanded the ability to reach distal brain arteries. We herein report recanalization, bleeding complications and short-term clinical outcomes with the smallest currently known low profile thrombectomy device in patients with primary or secondary distal medium vessel occlusion (DMVO).MethodsWe performed a retrospective analysis of 115 patients receiving mechanical thrombectomy (MT) in DMVO using the extended Thrombolysis in Cerebral Infarction (eTICI), European Cooperative Acute Stroke Study (ECASS) II classification, The National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores at admission and discharge to evaluate outcomes. Patients were stratified into three groups: (1) primary isolated distal occlusion (n=34), (2) secondary distal occlusion after MT of a proximal vessel occlusion (n=71), or (3) during endovascular treatment of aneurysms or arteriovenous malformations (AVMs) (n=10).ResultsSuccessful distal recanalization, defined as an eTICI score of 2b67, 2c and 3, was achieved in 74.7% (86/115) of patients. More specifically, it was 70.5% (24/34), 73.2% (52/71), and 100% (10/10) of primary DMVO, secondary DMVO after proximal MT, and rescue MT during aneurysm or AVM embolization, respectively. Symptomatic intraparenchymal bleeding occurred in 6.9% (eight patients). In-hospital mortality occurred in 18.1% (19/105) of patients with stroke. The most common cause of death was large infarct, old age, and therapy limitation.ConclusionDirect or rescue MT of DMVO using a very low profile thrombectomy device is associated with a high rate of successful recanalization and a reasonable rate of symptomatic hemorrhagic complication, despite a risk of 18.1% hospital mortality in elderly patients. Further trials are needed to confirm our results and assess long-term clinical outcomes.

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Section: Discussionmentioning

confidence: 73%

Effectiveness of very low profile thrombectomy device in primary distal medium vessel occlusion, as rescue therapy after incomplete proximal recanalization or following iatrogenic thromboembolic events

Rikhtegar

Mosimann

Weber

et al. 2021

J NeuroIntervent Surg

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“…Hassan and co-workers analysed the utilization of MT in the US from 2004 to 2007 (so called "post-MERCI" period) and from 2008 to 2009 (so called "post-Penumbra" period) and reported an overall endovascular treatment rate of 0.1% in 2004 and 0.6% in 2009 with a MT rate of only 0.2% in patients aged ≥85 years [24]. A more recent analysis from the National Inpatient Sample in the US reported an increase of MT use in stroke patients from 0.6% in 2008 to 1.1% in 2012 [25]. In a prospective Korean hospital based registry with up to 14 participating hospitals (mostly university hospitals in metropolitan areas) over the time period from April 2008 to November 2013, a total of 3517 of 27.851 (12.7%) stroke patients received any acute recanalization treatment, i.e.…”

Section: Discussionmentioning

confidence: 99%

Distribution and evolution of acute interventional ischemic stroke treatment in Germany from 2010 to 2016

Weber

Eyding

Kitzrow

et al. 2019

Neurol. Res. Pract.

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Background: Mechanical thrombectomy (MT) is a new evidence-based treatment option for large vessel occlusion in the anterior brain circulation. Using comprehensive administrative data from Germany, we analysed the nationwide development of intravenous thrombolysis (IVT) and MT in Germany between 2010 and 2016. Methods: We considered all documented cases (n = 1,515,634) with a main diagnosis of the ICD-10-GM code I63 (ischemic stroke) and identified specific stroke recanalization therapy by using the corresponding Operating and Procedure Key for systemic thrombolysis and mechanical thrombectomy out of the DRG statistics. Regional analyses are based on data from the 413 German administrative districts and cities and the obligatory quality reports of all hospitals. We distinguished between rates of MT related to place of residence of patients and place of treatment. Results: Coded ischemic strokes increased by 10.2% from 2010 (n = 206.688) to 2016 (n = 227.687). The rate of IVT increased from 8.9% in 2010 to 14.9% in 2016 and the rate of MT increased from 0.8% in 2010 to 4.7% in 2016 with a strong increase in 2015 and 2016. There was a high regional variability of MT according to place of residence of patients between 0 and 11.2% in 2016 with significant lower treatment rates in rural compared to urban areas (3.8 vs 5.4%). Mean age of patients treated with MT increased from 67.8 years in 2010 to 73.3 years in 2016 and almost reached the mean age of IVT treated patients (74.4 years). The number of hospitals coding MT increased from 91 to 193 from 2010 to 2016, but 80% of all MT procedures were performed in neurointerventional centers with ≥50 procedures/year in 2016. Conclusions: The rate of IVT in patients with acute ischemic stroke in Germany continues to rise and has reached 14.9% nationwide. The increase of MT is even more pronounced and was triggered by the evidence after publication of the MT randomized trials. There is still a high regional variability with significant lower MT rates in rural areas.

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“…Our results show a substantial increase in the proportion of all AIS managed with thrombectomy in the United States, from 0.1% in 2004, 0.6% in 2008, and 1.1% in 2012 (18,19) to 2.8% in 2016-2017. This increase in the use of thrombectomy did not benefit patients uniformly, suggesting that the demographic, socioeconomic, and regional disparities observed in stroke care before the thrombectomy era (20-23) remain persistent today.…”

Section: Rates Reasons and Risks For Readmissionmentioning

confidence: 66%

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

et al. 2021

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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

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Trends in mortality following mechanical thrombectomy for the treatment of acute ischemic stroke in the USA

Cited by 13 publications

References 29 publications

Effectiveness of very low profile thrombectomy device in primary distal medium vessel occlusion, as rescue therapy after incomplete proximal recanalization or following iatrogenic thromboembolic events

Effectiveness of very low profile thrombectomy device in primary distal medium vessel occlusion, as rescue therapy after incomplete proximal recanalization or following iatrogenic thromboembolic events

Distribution and evolution of acute interventional ischemic stroke treatment in Germany from 2010 to 2016

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

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