Inverse National Trends in Decompressive Craniectomy versus Endovascular Thrombectomy for Stroke

Area of Science:

• Neurology
• Interventional Cardiology
• Neurosurgery

Background:

• Acute large vessel occlusion stroke requires timely intervention.
• Endovascular thrombectomy (ET) is a key treatment for reducing infarct size.
• Decompressive craniectomy (DC) is used for severe strokes, but its necessity may be influenced by ET.

Purpose of the Study:

• To analyze national trends in the utilization of ET versus DC for stroke treatment in the United States.
• To investigate the relationship between ET and DC utilization over a 10-year period (2006-2016).

Main Methods:

• Retrospective cohort study using the Nationwide Inpatient Sample (NIS) database.
• Analysis of International Classification of Diseases-9/10 codes for stroke patients from 2006 to 2016.
• Comparison of utilization rates, patient demographics, outcomes, and hospital charges for ET and DC.

Main Results:

• Stroke patient interventions with ET or DC increased by 266% from 2006 to 2016.
• ET utilization rose from 0.19% to 14.07%, while DC utilization decreased from 7.07% to 6.43%.
• ET was associated with shorter hospital stays, lower mortality, higher discharge home rates, and reduced costs compared to DC.

Conclusions:

• A significant inverse relationship exists between ET and DC utilization for stroke treatment.
• The increasing adoption of ET correlates with a declining use of DC.
• Findings suggest that ET may reduce the need for DC in managing acute ischemic stroke.