Endovascular Therapy in Acute Ischemic Stroke: A Six-Year National Assessment of Utilization and Outcomes: Outcomes of Endovascular Therapy in Acute Stroke.

Abstract

Backgrounds: Ischemic stroke is a leading cause of death and disability worldwide. Endovascular treatment (EVT) is recognized as an effective intervention for acute ischemic stroke, but only a small fraction of patients with large vessel occlusion receive it. While EVT adoption has grown in the U.S., data on short- and long-term outcomes remain limited. This study aims to assess trends and in-hospital outcomes of stroke patients undergoing EVT.

Methods: We performed a retrospective cohort study using the Nationwide Inpatient Sample (NIS) database from 2016 to 2021. Adult patients hospitalized with LVO stroke involving the internal carotid or middle cerebral arteries were identified using ICD-10-CM codes and stratified by EVT status. Multivariable logistic regression and propensity score matching were used to adjust for baseline characteristics and evaluate in-hospital outcomes.

Results: Among 840,335 hospitalizations with LVO stroke, 103,355 (13.3%) underwent EVT. In the PSM analysis of matched cohort (n=18,460), EVT was associated with higher in-hospital mortality (10.4% vs. 5.6%, p<0.001), intracerebral hemorrhage (18.58% vs. 9.82%, p<0.001), periprocedural stroke (0.16% vs. 0.08%, p=0.035), cardiac arrest (2.93% vs. 1.37%, p<0.001), and major adverse cardiac events (13.10% vs. 8.08%, p<0.001), acute kidney injury (15.59% vs. 14.76%, p=0.025) and arrhythmias (52.96% vs. 41.40%, p<0.001). Seizure incidence was lower in the EVT group (1.87% vs. 2.58%, p<0.001).

Conclusions: Despite increased use of EVT, our study revealed that patients undergoing this intervention experienced higher in-hospital mortality and complication rates. These findings underscore the importance of patient selection and the need for further real-world studies to optimize EVT outcomes.