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

Abstract

Background: Mechanical thrombectomy (MT) is the standard of care for qualifying patients with acute ischemic stroke (AIS). Minimal postprocedural guidelines often result in patients being admitted to the intensive care unit (ICU) for 24 h, even if they did not receive intravenous thrombolysis (IVT). Whether or not these patients consistently use ICU resources has not been well studied. This study aims to assess the use of ICU resources in post-thrombectomy patients who did not receive IVT.

Methods: A single-center retrospective chart review was performed for all patients with AIS who were at least 18 years old and received MT from 2015 to 2022. Patients who received IVT or required ICU-level resources before MT were excluded. ICU-level resources were defined as advanced respiratory support (ARS), neurosurgical intervention, ICU-level infusions (e.g., hypertonic saline, vasoactive, sedating), or interventions requiring ICU-level nursing care. We collected data on patient demographics, stroke characteristics, and the use of ICU-level resources up to 24 h after MT. A multivariate logistic regression model was used to determine the factors associated with ICU resource use.

Results: A total of 239 patients met the inclusion criteria. The median admission National Institute of Health Stroke Scale score was 16. Of these patients, 128 (53.6%) did not require ICU resources in the first 24 h, and 111 (46.4%) did. Vasoactive infusions and ARS were the most used resources (n = 86 [77.4%] and n = 55 [49.5%]). Vasoactive infusions and ARS started during MT were the only statistically significant variables associated with the use of ICU-level resources in the 24 h postprocedure (odds ratio [OR] 2.92, p < 0.001; and OR 2.33, p = 0.009).

Conclusions: Most patients who did not receive IVT do not require ICU resources in the first 24 h after MT. Multivariate analysis revealed the only statistically significant factors predicting the need for ICU resources was the use of ARS and vasoactive infusions during MT. These results suggest it may be reasonable to reexamine current monitoring paradigms.