Background Little is known about the national regional variations in the care and outcomes of acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) within the United States (US). This study aims to investigate regional variation in EVT outcomes for AIS.

Methods Using the National Inpatient Sample (2016-2020), we identified adults hospitalized for AIS who underwent EVT. Patients were subclassified geographically by nine United States census regions: East North Central (ENC), East South Central (ESC), Middle Atlantic (MA), Mountain (Mtn), New England (NE), Pacific (Pa), South Atlantic (SA), West North Central (WNC), and West South Central (WSC). Data including demographic, comorbidities, and intravenous thrombolysis (IVT) rates were collected. Nearest-neighbor matching was performed among patients who received EVT based on age, gender, NIHSS, and comorbidities. Comparative analyses with Chi-squared tests for categorical variables and Kruskal-Wallis tests for continuous variables were performed to identify differences in outcomes among regions. Primary outcomes included favorable functional outcomes discharge home without assistance or discharged to a rehabilitation hospital). Secondary outcomes included in-hospital mortality and functional independence (discharge to home without assistance).

Results There were 121,970 cases of EVT collected. There were significant differences in age among patients receiving EVT among the regions (p<0.001), with the lowest average age of 68.37 ± 13.72 in ESC and the highest average age of 72.43 ± 13.74 in NE. There were significant differences in presenting NIHSS of EVT patients between the regions (p=0.006), with the highest average of 17.38 in Pa and the lowest average of 16.17 in the SA. Rates of diabetes, dyslipidemia, hypertension, kidney disease, and CHF were also significantly different among the regions (p<0.001). After nearest-neighbor matching, outcomes also varied significantly between regions. Favorable functional outcomes varied significantly between regions (p=0.006), with the highest rates of 30.38% in Pa and the lowest rate of 16.60% in NE. Functional independence significantly differed among regions (p<0.001), with the highest rate of 22.85% in WNC and the lowest rate of 13.87% in NE. In-hospital mortality rates differed significantly among regions (p<0.001), with the highest rates of 13.77% in ESC and the lowest rate of 10.60% in the SA.

Conclusions There remain significant regional differences in the outcomes of EVT for AIS. More analysis is required to determine what is driving these differences. More work is needed to ensure optimal and equitable patient outcomes.

Disclosures A. Brake: None. L. Fry: None. G. LeBeau: None. C. Heskett: None. C. Lei: None. A. Alkiswani: None. K. Le: None. F. De-Stefano: None. J. Peterson: None. K. Ebersole: None.