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Abstract Details

National Trends In Utilization And Outcomes Of Endovascular Treatment In Acute Ischemic Stroke Patients In Pre- And Post-stent Retriever Era In The United States
Cerebrovascular Disease and Interventional Neurology
P4 - Poster Session 4 (5:30 PM-6:30 PM)
4-006
We performed this analysis to evaluate trends in utilization of endovascular treatment in acute ischemic stroke and rates of death and disability. 
Several studies have shown improved outcomes in ischemic stroke patients treated with mechanical thrombectomy in clinical trials after introduction of stent retrievers. The outcomes of patients undergoing endovascular treatment in general practice are expected to improve.
We obtained data for patients admitted with primary diagnosis of ischemic stroke in United States from 2009-2016 using Nationwide Inpatient Sample. We determined the rate and pattern of utilization, and associated in-hospital outcomes of endovascular treatment among them. Outcomes were classified as minimal disability, moderate to severe disability, and death based on discharge disposition and compared between two time periods: 2009-2011 and 2013-2016 to represent pre and post stent retriever approvals in United States.
Of the 3,780,955 patients admitted with ischemic stroke, 244,092 (6.46%) received intravenous thrombolytic treatment, and 48,409 (1.28%) underwent endovascular treatment. There was a fourfold increase in patients who underwent endovascular treatment (0.55% of ischemic strokes in 2009 vs. 2.03% in 2016, trend p < 0.001). In multivariate logistic regression analysis, adjusted for age, gender, thrombolytic therapy, in hospital complications including secondary intracranial hemorrhages, the rate of none to minimal disability improved between the two study intervals (2009-2011 versus 2013-2016), odds ratio (OR) 1.82, 95% confidence interval (CI) 1.47-2.67, p=<0.0001) and moderate to severe disability decreased (OR 0.56, 95% CI 0.45- 0.70, p= <0.0001). There was significant decrease inpatient mortality for patients treated during 2013-2016; OR 0.67, 95% CI 0.56- 0.79, p= <0.0001).
There has been a significant increase in the proportion of acute ischemic stroke patients receiving endovascular treatment with improvement of outcomes. Our analysis support generalizability of the successful results observed in clinical trials of endovascular treatment in the post-stent retriever approval era in United States.
Authors/Disclosures
Saqib A. Chaudhry, MD
PRESENTER 		Dr. Chaudhry has nothing to disclose.
Ameer Hassan, DO (Valley Baptist Medical Center) Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Penumbra. Dr. Hassan has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Cerenovus. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Viz.ai. Dr. Hassan has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Hassan has received research support from GE Healthcare.
No disclosure on file
No disclosure on file
Sairah Bashir, MD, FÂ鶹´«Ã½Ó³»­ Dr. Bashir has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic .
No disclosure on file
Lakshmi P. Digala, MD (Univerity of Missouri Health Care) Dr. Digala has nothing to disclose.
Muhammad F. Suri, MD (St Cloud Hospital) Dr. Suri has nothing to disclose.
No disclosure on file
Camilo R. Gomez, MD, FÂ鶹´«Ã½Ó³»­ (University of Missouri) Dr. Gomez has nothing to disclose.
Farhan Siddiq, MD Dr. Siddiq has nothing to disclose.
Hamza I. Maqsood, MD (Dept of Neurology) Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.