Article Text

Download PDFPDF
Original research
Mechanical thrombectomy in patients with acute ischemic stroke in the USA before and after time window expansion
  1. Chun Shing Kwok1,2,
  2. Syed A Gillani3,
  3. Navpreet K Bains3,
  4. Camilo R Gomez3,
  5. Daniel F Hanley4,
  6. Daniel E Ford4,
  7. Ameer E Hassan5,
  8. Thanh N Nguyen6,
  9. Farhan Siddiq7,
  10. Alejandro M Spiotta8,
  11. Adnan I Qureshi3
  1. 1 Department of Post Qualifying Healthcare Practice, Birmingham City University, Birmingham, UK
  2. 2 Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  3. 3 Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
  4. 4 Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
  5. 5 Department of Neurology, University of Texas Rio Grande Valley, Harlingen, Texas, USA
  6. 6 Neurology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
  7. 7 Neurosurgery, University of Missouri, Columbia, Missouri, USA
  8. 8 Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Chun Shing Kwok, Department of Post Qualifying Healthcare Practice, Birmingham City University, Birmingham, UK; shingkwok{at}doctors.org.uk

Abstract

Background In 2018, the time window for mechanical thrombectomy eligibility in patients with acute ischemic stroke increased from within 6 hours to within 24 hours of symptom onset. The purpose of this study was to evaluate the effect of window expansion on procedural and hospital volumes and patient outcomes at a national level.

Methods We conducted a retrospective cohort study of patients with acute ischemic stroke undergoing mechanical thrombectomy using data from the National Inpatient Sample. We compared the numbers of mechanical thrombectomy procedures and performing hospitals between 2017 and 2019 in the USA, and the proportion of patients discharged home/self-care, those with in-hospital mortality and post-procedural intracranial hemorrhage (2019 vs 2017) after adjustment for potential confounders.

Results The number of patients with ischemic stroke who underwent mechanical thrombectomy increased from 16 960 in 2017 to 28 120 in 2019. There was an increase in the number of hospitals performing mechanical thrombectomy (501 in 2017, 585 in 2019) and those performing ≥50 procedures/year (97 in 2017, 199 in 2019; P<0.001). The odds of in-hospital mortality decreased (OR 0.79, 95% CI 0.66 to 0.94, P=0.008) and the odds of intracranial hemorrhage increased (OR 1.18, 95% CI 1.06 to 1.31, P=0.003) in 2019 compared with 2017, with no change in odds of discharge to home.

Conclusions The window expansion for mechanical thrombectomy for patients with acute ischemic stroke was associated with an increase in the numbers of mechanical thrombectomy procedures and performing hospitals with a reduction of in-hospital mortality in the USA.

  • Thrombectomy
  • Stroke
  • Hemorrhage

Data availability statement

Data may be obtained from a third party and are not publicly available.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data may be obtained from a third party and are not publicly available.

View Full Text

Footnotes

  • Contributors AIQ conceptualized the study, acquired the data, interpreted the results and helped write the first draft of the manuscript. CSK analysed the data, interpreted the results and helped write the first draft of the manuscript. SAG, NKB, CRG, DH, DEF, AEH, TNN, FS, and AMS revised the manuscript critically for important intellectual content. All authors gave approval for the final version to be published and AIQ is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AEH: Consultant and honorarium: Medtronic, Microvention, Stryker, Penumbra, Cerenovus, Genentech, GE Healthcare, Scientia, Balt, Viz.ai, Insera Therapeutics, Proximie, NeuroVasc, NovaSignal, Vesalio, Rapid Medical, Imperative Care and Galaxy Therapeutics. No competing interests for the other authors.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.