Abstract 278: Patterns of Mechanical Thrombectomy for Stroke Before and After the 2015 Pivotal Trials:5 Years Follow‐up
Introduction The 2015 American Heart Association Guidelines recommended mechanical thrombectomy with stent‐retriever devices. A prior published analysis of national trends after one year in mechanical thrombectomy use and outcomes for stroke before and after publication of the 2015 US guideline upda...
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| Format: | Article |
| Language: | English |
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Wiley
2023-11-01
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| Series: | Stroke: Vascular and Interventional Neurology |
| Online Access: | https://www.ahajournals.org/doi/10.1161/SVIN.03.suppl_2.278 |
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| author | Yaswanth S Chintaluru Kunakorn Atchaneeyasakul Nicholas Liaw Keiko Fukuda Aldo Mendez Okkes Kuybu Shasvat Desai Agostinho Pinheiro Ashutosh Jadhav Kathryn C Fitzgerald Bradley Gross Sandra Narayanan Raul Nogueira Michael Lang |
| author_facet | Yaswanth S Chintaluru Kunakorn Atchaneeyasakul Nicholas Liaw Keiko Fukuda Aldo Mendez Okkes Kuybu Shasvat Desai Agostinho Pinheiro Ashutosh Jadhav Kathryn C Fitzgerald Bradley Gross Sandra Narayanan Raul Nogueira Michael Lang |
| author_sort | Yaswanth S Chintaluru |
| collection | DOAJ |
| description | Introduction The 2015 American Heart Association Guidelines recommended mechanical thrombectomy with stent‐retriever devices. A prior published analysis of national trends after one year in mechanical thrombectomy use and outcomes for stroke before and after publication of the 2015 US guideline update showed improved functional outcomes and lower peri‐procedural mortality. We analyze the national trends in mechanical thrombectomy use and outcomes for stroke five years after publication of the US guideline update. Methods We analyzed the National Inpatient Sample from 2012‐2019. ICD‐9 and ICD‐10 codes identified Ischemic stroke and mechanical thrombectomy patients. Similar to the previous study, discharge to home was the primary efficacy outcome measure in this study since it strongly correlates with mild degree of disability at discharge and 3 months post‐stroke. Safety outcomes include in‐hospital medical complications and mortality. We utilized multivariate logistic regression to assess outcomes. Results From 2012‐2019, 4,003,405 individuals with a diagnosis of ischemic stroke were recorded, 103,605 (2.6%) of which were treated with mechanical thrombectomy, proportionally increased from 4,910/452,905 (1.1%) in 2012 to 26,365/552,780 (4.8%) in 2019. The proportion of endovascular thrombectomy performing hospitals nearly doubled during the study period from 2012 (295/4,378; 6.7%) to 2019 (582/4,568; 12.7%). Odds of a mild disability outcome increased from 16% to 20%, OR 0.65 (0.57, 0.74), while mortality decreased from 15% to 12%, OR 0.69 (0.61, 0.78). Compared with 2012‐2014, the 2015‐2019 cohort showed increased odds of ICH and shock while the odds of DVT, pulmonary embolism, pneumonia, and UTI were significantly lower. The presence of septicemia, shock, and cardiac arrest were unchanged. Conclusion The number of large vessel occlusion stroke patients receiving mechanical thrombectomy treatment in the United States is increasing rapidly each year after the 2015 US guideline update. As the use of mechanical thrombectomy expands, included patients have more medical complications at baseline, but experience fewer complications, peri‐procedural mortality and overall improved outcomes. |
| format | Article |
| id | doaj-art-c0e5df8744f3478fa82decf5eb446935 |
| institution | Kabale University |
| issn | 2694-5746 |
| language | English |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Stroke: Vascular and Interventional Neurology |
| spelling | doaj-art-c0e5df8744f3478fa82decf5eb4469352025-08-20T03:53:51ZengWileyStroke: Vascular and Interventional Neurology2694-57462023-11-013S210.1161/SVIN.03.suppl_2.278Abstract 278: Patterns of Mechanical Thrombectomy for Stroke Before and After the 2015 Pivotal Trials:5 Years Follow‐upYaswanth S Chintaluru0Kunakorn Atchaneeyasakul1Nicholas Liaw2Keiko Fukuda3Aldo Mendez4Okkes Kuybu5Shasvat Desai6Agostinho Pinheiro7Ashutosh Jadhav8Kathryn C Fitzgerald9Bradley Gross10Sandra Narayanan11Raul Nogueira12Michael Lang13University of Colorado School of Medicine Colorado United StatesVirginia Mason Franciscan Health Washington United StatesN/A Nevada United StatesUCLA California United StatesUPMC Pennsylvania United StatesUPMC Pennsylvania United StatesBarrow Neurological Institute Arizona United StatesBarrow Neurological Institute Arizona United StatesBarrow Neurological Institute Arizona United StatesJohns Hopkins Bloomberg School of Public Health Maryland United StatesUPMC Pennsylvania United StatesPacific Neuroscience Institute California United StatesUPMC Pennsylvania United StatesUPMC Pennsylvania United StatesIntroduction The 2015 American Heart Association Guidelines recommended mechanical thrombectomy with stent‐retriever devices. A prior published analysis of national trends after one year in mechanical thrombectomy use and outcomes for stroke before and after publication of the 2015 US guideline update showed improved functional outcomes and lower peri‐procedural mortality. We analyze the national trends in mechanical thrombectomy use and outcomes for stroke five years after publication of the US guideline update. Methods We analyzed the National Inpatient Sample from 2012‐2019. ICD‐9 and ICD‐10 codes identified Ischemic stroke and mechanical thrombectomy patients. Similar to the previous study, discharge to home was the primary efficacy outcome measure in this study since it strongly correlates with mild degree of disability at discharge and 3 months post‐stroke. Safety outcomes include in‐hospital medical complications and mortality. We utilized multivariate logistic regression to assess outcomes. Results From 2012‐2019, 4,003,405 individuals with a diagnosis of ischemic stroke were recorded, 103,605 (2.6%) of which were treated with mechanical thrombectomy, proportionally increased from 4,910/452,905 (1.1%) in 2012 to 26,365/552,780 (4.8%) in 2019. The proportion of endovascular thrombectomy performing hospitals nearly doubled during the study period from 2012 (295/4,378; 6.7%) to 2019 (582/4,568; 12.7%). Odds of a mild disability outcome increased from 16% to 20%, OR 0.65 (0.57, 0.74), while mortality decreased from 15% to 12%, OR 0.69 (0.61, 0.78). Compared with 2012‐2014, the 2015‐2019 cohort showed increased odds of ICH and shock while the odds of DVT, pulmonary embolism, pneumonia, and UTI were significantly lower. The presence of septicemia, shock, and cardiac arrest were unchanged. Conclusion The number of large vessel occlusion stroke patients receiving mechanical thrombectomy treatment in the United States is increasing rapidly each year after the 2015 US guideline update. As the use of mechanical thrombectomy expands, included patients have more medical complications at baseline, but experience fewer complications, peri‐procedural mortality and overall improved outcomes.https://www.ahajournals.org/doi/10.1161/SVIN.03.suppl_2.278 |
| spellingShingle | Yaswanth S Chintaluru Kunakorn Atchaneeyasakul Nicholas Liaw Keiko Fukuda Aldo Mendez Okkes Kuybu Shasvat Desai Agostinho Pinheiro Ashutosh Jadhav Kathryn C Fitzgerald Bradley Gross Sandra Narayanan Raul Nogueira Michael Lang Abstract 278: Patterns of Mechanical Thrombectomy for Stroke Before and After the 2015 Pivotal Trials:5 Years Follow‐up Stroke: Vascular and Interventional Neurology |
| title | Abstract 278: Patterns of Mechanical Thrombectomy for Stroke Before and After the 2015 Pivotal Trials:5 Years Follow‐up |
| title_full | Abstract 278: Patterns of Mechanical Thrombectomy for Stroke Before and After the 2015 Pivotal Trials:5 Years Follow‐up |
| title_fullStr | Abstract 278: Patterns of Mechanical Thrombectomy for Stroke Before and After the 2015 Pivotal Trials:5 Years Follow‐up |
| title_full_unstemmed | Abstract 278: Patterns of Mechanical Thrombectomy for Stroke Before and After the 2015 Pivotal Trials:5 Years Follow‐up |
| title_short | Abstract 278: Patterns of Mechanical Thrombectomy for Stroke Before and After the 2015 Pivotal Trials:5 Years Follow‐up |
| title_sort | abstract 278 patterns of mechanical thrombectomy for stroke before and after the 2015 pivotal trials 5 years follow up |
| url | https://www.ahajournals.org/doi/10.1161/SVIN.03.suppl_2.278 |
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