Trends in device utilization and procedural outcomes of endovascular treatment of acute ischemic stroke: A 10-year review of individual institutional experience.

BackgroundMost of endovascular thrombectomy (EVT) procedures are performed outside of clinical trials, thus the data available from such trials is often not reflective of real-world practice. How specific indications for EVT or new techniques evolve or impact procedural outcomes in individual patients remains largely unknown.MethodsFrom 2013 to 2023, demographic, clinical and procedural data was collected on consecutive first 20 EVT procedures at the beginning of each year. Trends in utilization of thrombectomy devices and correlations with procedural outcomes were investigated.ResultsThere was a significant difference in the distribution of target occlusion sites (<0.001) with a trend towards a higher proportion of distal occlusions treated with EVT in more recent years. Aspiration-first approach to EVT became more frequent whereas the frequency of stent retriever-first approach decreased (p < 0.001). Average duration of the EVT procedure decreased dramatically (p < 0.001, r = 0.7). In 2013-2015 versus 2022-2023, mean duration of thrombectomy was 128 and 41 min, respectively. However, the number of passes, rates of first pass effect, final TICI 2b/3 and TICI 2c/3 reperfusion remained largely unchanged (p > 0.1 for each metric).ConclusionsOur analysis demonstrates continuous changes in target population of patients with acute stroke treated with EVT and procedural techniques used by operators. While the average duration of the procedure has decreased dramatically, its technical success has remained largely unchanged. This indicates continuous unmet need for future innovation in this field of neurointervention.