Trends in Endovascular Stroke Treatment | Journal Scan

Study Questions:

What are the trends in use of, and hospital and patient characteristics associated with, endovascular therapy for acute ischemic stroke?

Methods:

The authors used data from Get With The Guidelines-Stroke hospitals from April 1, 2003 to June 30, 2013, and assessed trends in number of hospitals providing endovascular therapy, the use of endovascular therapy in these hospitals, and clinical outcomes.

Results:

Of the 1,087 hospitals in the registry, 454 provided endovascular therapy to at least one patient during the study period. From 2003 to 2012, the proportion of hospitals providing endovascular therapy increased from 12.9% to 28.9% (p < 0.0001), with a modest drop to 23.4% in 2013. Utilization of endovascular therapy increased from 0.7% to 2% (p < 0.001). The rate of symptomatic intracerebral hemorrhage among endovascular therapy treated patients was 9.7%. An improvement in patient outcomes after endovascular therapy was observed over time, with reductions in in-hospital mortality (29.6% in 2004 to 16.2% in 2013; p = 0.002); and from late 2010, reduction in symptomatic intracerebral hemorrhage (11% in 2010 to 5% in 2013; p < 0.0001), increased independent ambulation at discharge (24.5% in 2010 to 33% in 2013; p < 0.0001), and discharge home (17.7% in 2010 to 26.1% in 2013; p < 0.0001).

Conclusions:

The authors concluded that endovascular therapy is slowly seeing increased use, and the outcomes have improved in the last few years.

Perspective:

This study demonstrates that endovascular therapy is uncommonly used in patients with stroke. The recent randomized trials demonstrate much better outcomes among patients treated with newer-generation devices, and it is likely that there will be greater uptake of this approach in clinical practice in the near future. The improvement in outcome of these patients over time is encouraging, but the low proportion of patients who recover enough to be discharged home (26% in 2013) calls for further research toward defining and delivering the optimal treatment of large stroke.

Clinical Topics: Invasive Cardiovascular Angiography and Intervention, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Endovascular Procedures, Stroke, Outcome Assessment (Health Care), Cerebral Hemorrhage, Hospital Mortality, Patient Discharge, Registries, Angiography


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