Mechanical Thrombectomy for Acute Ischemic Stroke Performed at High-Volume Institutions Results in Better Patient Outcomes.

PURPOSE: To examine the relationship between patient outcomes and mechanical thrombectomy (MT) volumes since the implementation of extended time window thrombectomies.

MATERIALS AND

METHODS

Data were obtained from the National Inpatient Sample (NIS) maintained by the Agency for Healthcare Research and Quality. The annual volumes of MT were collected at the institutional level during 2017-2021 using the International Classification of Diseases, 10th Revision, Clinical Modification, codes. For the statistical analysis, a multivariate logistic regression analysis was used to analyze the effect of MT volume on mortality while controlling for the following: race, age, case complication, institution bed size, institution region, and institutional location/teaching status.

RESULTS

There were 27,797 MT cases identified in the NIS during 2017-2021, which corresponds to a national estimate of 138,985 total cases during this timeframe. Case volumes increased every year from 2017 to 2021. Over this time period, there was a 1.2% reduction in odds of mortality per every 10 MT case increase (odds ratio, 0.988; 95% CI, 0.980-0.995; P = .001. The total complication rate in this series of patients was 71.7%, with 40.5% of all patients having cardiac complications and 30.5% of all patients having pulmonary complications.

CONCLUSIONS

Improved MT outcomes continue to be observed at high-volume institutions despite the implementation of the extended time window for thrombectomy, although cardiac and pulmonary complications constitute a significant source of morbidity and may represent an opportunity to improve outcomes at low-volume centers.