Medical Complications After Mechanical Thrombectomy: Analysis of Trends in US Admissions From 2010 to 2022

The prevalence of medical complications in patients with acute ischemic stroke undergoing mechanical thrombectomy (MT) is sparse. This study aims to quantify and evaluate trends in common medical complications in acute ischemic stroke MT hospitalizations in the United States over the past decade.

We utilized the 2010 to 2022 Nationwide Inpatient Sample (NIS) to conduct a serial cross-sectional study. All adult acute ischemic stroke MT hospitalizations (aged ≥18 years) were identified using International Classification of Diseases codes. We computed the weighted prevalence of acute myocardial infarction, acute renal failure, deep venous thrombosis, gastrointestinal bleeding (GIB), pneumonia, pulmonary embolism, sepsis, and urinary tract infection (UTI) across age and sex strata. Poisson regression models were utilized to evaluate the association of each complication with hospital-level factors and to study trends over time.

Among 233 812 weighted MT hospitalizations (50.3% women; mean age 68.9 years), 35.9% had at least 1 complication. The age and sex-standardized prevalence was highest for acute renal failure (15.6%), UTI (11.3%), and pneumonia (6.8%), whereas acute myocardial infarction (4.7%), GIB (2%), deep venous thrombosis (4.3%), and pulmonary embolism (1.9%) were less common. Disparities in complication burden were present by age/sex (GIB: women 18-39 years, 0.9%; men ≥80 years, 2.7%). Age/sex-standardized prevalence of acute renal failure increased ≈2-fold across the study period from 11.0% in 2010 to 18.5% in 2022, whereas prevalence of sepsis, pulmonary embolism, and acute myocardial infarction also increased marginally over time (all P-for-trend <0.05; deep venous thrombosis rose 5%/y in women; UTI declined in both sexes; pneumonia declined in men (all P-for-trend <0.05); GIB was stable. We report prevalence risk ratios (PRRs); for example, PRR 1.81 indicates an 81% higher prevalence. Each unit increase in National Institutes of Health Stroke Scale score (UTI PRR, 1.02 [95% CI, 1.01-1.02]) and early mechanical ventilation (pneumonia PRR, 3.41 [95% CI, 3.03-3.83]) were associated with increased prevalence of all complications, while intravenous thrombolysis was associated with lower risk for most events (UTI: PRR, 0.91 [95% CI, 0.86-0.96]; sepsis: PRR, 0.77 [95% CI, 0.70-0.84]; pneumonia: PRR, 0.81 [95% CI, 0.75-0.88]). Mortality fell from 23.7% (2010) to 11.8% (2022), whereas routine home discharge rose from 11.9% to 19.9%. All complications were associated with a lower likelihood of routine home discharge, and all except UTI were associated with an increase in in-hospital mortality (sepsis: PRR, 1.55 [95% CI, 1.42-1.67]).

The prevalence of pneumonia and UTI declined, whereas acute renal failure prevalence more than doubled in acute ischemic stroke MT hospitalizations over the last decade. Complications were consistently linked to poorer discharge outcomes and higher in-hospital mortality, underscoring the need for targeted prevention strategies to optimize postthrombectomy care.