Resource Utilization After Mechanical Thrombectomy: Is ICU Care Required for All Patients?

Area of Science:

• Neurology
• Critical Care Medicine
• Interventional Neuroradiology

Background:

• Mechanical thrombectomy (MT) is the standard of care for acute ischemic stroke (AIS).
• Current guidelines often mandate 24-hour intensive care unit (ICU) admission post-MT, even for patients not receiving intravenous thrombolysis (IVT).
• The necessity and utilization of ICU resources in this patient subgroup remain understudied.

Purpose of the Study:

• To assess the utilization of ICU resources within 24 hours post-mechanical thrombectomy for acute ischemic stroke patients who did not receive intravenous thrombolysis.
• To identify factors associated with ICU resource use in this specific patient population.

Main Methods:

• A single-center retrospective chart review of adult AIS patients who underwent MT between 2015 and 2022.
• Exclusion criteria included prior IVT or need for ICU-level resources before MT.
• ICU-level resources included advanced respiratory support (ARS), neurosurgical intervention, specific infusions, or nursing care interventions.

Main Results:

• Out of 239 eligible patients, 53.6% did not require ICU resources in the first 24 hours post-MT.
• Vasoactive infusions (77.4%) and ARS (49.5%) were the most frequently used ICU resources.
• Initiation of vasoactive infusions and ARS during MT were significant predictors of subsequent ICU resource utilization (OR 2.92, p<0.001; OR 2.33, p=0.009, respectively).

Conclusions:

• A majority of AIS patients treated with MT, but without IVT, do not necessitate intensive care monitoring for 24 hours.
• The use of advanced respiratory support and vasoactive infusions during the MT procedure are the primary indicators for requiring ICU-level resources post-procedure.
• Findings suggest a potential need to revise current post-procedural monitoring protocols for these patients.