Cranial neurosurgery procedure utilization among patients with acute ischemic stroke

Area of Science:

• Neurology
• Neurosurgery
• Public Health

Background:

• Concerns regarding neurosurgery availability may impede timely thrombolysis for acute ischemic stroke (AIS).
• Randomized trials on the necessity of backup neurosurgery for AIS are impractical.
• Analysis of routine clinical practice offers insights into neurosurgical procedure utilization in AIS.

Purpose of the Study:

• To analyze the frequency and temporal trends of cranial neurosurgical procedures in AIS patients.
• To investigate the impact of intravenous thrombolysis on neurosurgical procedure rates.
• To examine the relationship between neurosurgery, thrombolysis, and intracerebral hemorrhage (ICH).

Main Methods:

• Utilized data from the Nationwide Inpatient Sample (1998-2006) for AIS patients undergoing cranial neurosurgery.
• Employed multivariate logistic regression with covariate adjustment for statistical analysis.
• Stratified results by thrombolysis status and included ICH as a key covariate.

Main Results:

• Intravenous thrombolysis use increased significantly from 0.8% to 2.5% (P<.001).
• Cranial neurosurgical procedures were infrequent but increased over time (0.12% to 0.19%; P=.0013).
• Thrombolysis doubled the odds of a neurosurgical procedure (OR 2.18; P<.001), but this effect was significant only in the absence of ICH (P<.001).

Conclusions:

• Intravenous thrombolysis should not be withheld from eligible AIS patients due to concerns about neurosurgery access.
• Neurosurgical procedure rates are low in routine practice, even post-thrombolysis.
• Further research is needed to clarify the role of standby neurosurgery and the specific link to ICH in AIS management.