Related Experiment Video
Updated: Dec 26, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Inverse National Trends in Decompressive Craniectomy versus Endovascular Thrombectomy for Stroke
Nicolas K Khattar1, Beatrice Ugiliweneza1, Enzo M Fortuny1
1Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
Insights
Endovascular thrombectomy (ET) use increased significantly for stroke treatment, while decompressive craniectomy (DC) use decreased. Findings suggest ET may reduce the need for DC in stroke patients.
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.
Objective:
Endovascular thrombectomy (ET) for acute large vessel occlusion reduces infarct size, and it should hypothetically decrease the incidence of major ischemic strokes requiring decompressive craniectomy (DC). The aim of this retrospective cohort study is to determine trends in the utilization of ET versus DC for stroke in the United States over a 10-year span.
Methods:
We extracted data from the Nationwide Inpatient Sample using International Classification of Diseases-9/10 codes from 2006-2016. Patients with a primary diagnosis of stroke were included. Baseline demographics, outcomes, and hospital charges were analyzed.
Results:
The study cohort comprised 14,578,654 patients diagnosed with stroke. During the study period, DC and ET were performed in 124,718 and 62,637 patients, respectively. The number of stroke patients who underwent either ET or DC increased by 266% from 2006 to 2016. During that time period, the ET utilization rate increased (0.19% in 2006 to 14.07% in 2016, P < 0.0004), whereas the DC utilization rate decreased (7.07% in 2006 to 6.43% in 2016, P < 0.0001). In 2015, the utilization rate of ET (9.73%) exceeded that of DC (9.67%). ET-treated patients had shorter hospitalization durations (mean 8.8 vs. 16.8 days, P < 0.0001), lower mortality (16.2% vs. 19.3%), higher likelihood of discharge home (27.1% vs. 24.1%, P < 0.0001), and reduced hospital charges (mean $189,724 vs. $261,314, P < 0.0001).
Conclusions:
We identified an inverse relationship between national trends in rising ET and diminishing DC utilization for stroke treatment over a recent decade. Although direct causation cannot be inferred, our findings suggest that ET curtails the necessity for DC.
