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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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Trends in mechanical thrombectomy and decompressive hemicraniectomy for stroke: A multicenter study
Chesney S Oravec1, Christine Tschoe1, Kyle M Fargen1
1Department of Neurosurgery, Wake Forest Baptist Medical Center, USA.
The Neuroradiology Journal
|July 16, 2021
Summary
Mechanical thrombectomy (MT) for emergent large vessel occlusion (ELVO) increased significantly between 2013-2018. However, rates of stroke admissions, tPA, and decompressive hemicraniectomy (DHC) remained stable, contrary to prior expectations.
Area of Science:
- Neurology
- Interventional Neurology
- Stroke Medicine
Background:
- Mechanical thrombectomy (MT) has demonstrated efficacy for emergent large vessel occlusion (ELVO) stroke.
- There was an anecdotal decrease in decompressive hemicraniectomy (DHC) for malignant cerebral edema post-MT trials.
- Understanding procedural trends is crucial for stroke care management.
Purpose of the Study:
- To correlate trends in stroke admissions, MT, and DHC rates over time.
- To analyze procedural changes following key thrombectomy trial publications (2013, 2015, post-DAWN/DEFUSE 3).
Main Methods:
- Multicenter retrospective study of 55,247 stroke admissions across 11 high-volume US stroke centers (2013-2018).
- Analysis of tissue plasminogen activator (tPA), MT, and DHC rates using procedural codes.
- Statistical modeling to assess changes in procedure rates over time.
Main Results:
- A significant increase in MT rates was observed (p=0.002).
- Stroke admissions, tPA administration rates, and DHC rates remained stable.
- No significant change in DHC utilization was associated with increased MT rates.
Conclusions:
- Real-world data confirm increased MT utilization for ELVO.
- Stable rates of stroke admissions, tPA, and DHC suggest evolving treatment paradigms.
- Increased MT does not appear to decrease DHC utilization in this cohort.
