Background and purpose Ischemic stroke is a major cause of disability and death in the USA. Intravenous tissue plasminogen activator (t-PA) remains underutilized. With the development of newer intra-arterial reperfusion therapies, there is increased opportunity to address the more devastating large-vessel occlusions. We seek to identify the numbers of patients with stroke treated with intravenous and intra-arterial therapies, as well as to estimate the potential number of intra-arterial cases in the foreseeable future.
Methods We performed a literature search to determine case volumes of intravenous t-PA use. We extrapolated the current case volume of intra-arterial stroke therapies from the numbers of cases in which the Merci retrieval device was used. In order to estimate the potential numbers of intra-arterial stroke cases, we characterized the percentage of patients with stroke who received intra-arterial therapy at two leading stroke centers. We applied these percentages to the numbers of patients with stroke seen at the top 100, 200 and 500 stroke centers by volume.
Results The rate of intravenous t-PA use is 2.4–3.6%, resulting in 15 000–22 000 cases/year in the USA. The estimated case volume of intra-arterial therapies is 3500–7200 in 2006. Based on data from St. Luke's Brain and Stroke Institute and Massachusetts General Hospital, approximately 5–20% of patients with ischemic stroke can be treated with intra-arterial therapies. Extrapolating this to the top 500 stroke centers by volume, the potential number of intra-arterial cases in the USA is 10 400–41 500/year.
Conclusion Based on the current numbers of intra-arterial cases, our theoretical model identifies a potential for significant growth of this stroke therapy.
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Competing interests JH: Merci Registry Steering Committee (no financial compensation); RN: Concentric Medical, Inc. (Physician Advisory Board, Consultant, Lecturer - modest, no stocks), ev3 (Physician Advisory Board, Consultant, Lecturer - modest, no stocks), Coaxia (Physician Advisory Board, Consultant, Lecturer - modest, no stocks); LS: Coaxia Inc (medical advisory board, compensated consultant for stroke device trial design), RTI Health Inc (compensated consultant, economic analysis of MRI-selected patients for thrombolysis; JP: ev3 Inc (procedural proctor, lecturer, advisory board - no financial compensation); RG: Bayer, GE (consultant - no financial compensation).
Funding AY was the 2007 recipient of the Neuroradiology Education and Research Foundation/Boston Scientific Fellowship in Cerebrovascular Disease Research. LAV was a 2007 recipient of the Howard Hughes Medical Institute Research Training Fellowships for Medical Students.
Ethics approval We received approval from the MGH Institutional Review Board for the retrospective analysis of the number of stroke therapies at our hospital and the percentage receiving intra-arterial therapy.