Ten-year trends, disparities, and clinical impact of stroke thrombectomy and thrombolysis: A single center experience 2012-2021

J Stroke Cerebrovasc Dis. 2024 Oct;33(10):107914. doi: 10.1016/j.jstrokecerebrovasdis.2024.107914. Epub 2024 Aug 2.

Abstract

Objectives: As indications for acute ischemic stroke treatment expand, it is unclear whether disparities in treatment utilization and outcome still exist. The main objective of this study was to investigate disparities in acute ischemic stroke treatment and determine impact on outcome.

Materials and methods: Retrospective observational cohort study of consecutive ischemic stroke admissions to a comprehensive stroke center from 2012-2021 was performed. Primary exposure was intravenous thrombolysis and/or endovascular thrombectomy. Primary end points were discharge modified Rankin Scale, home disposition, and expired/hospice. Multivariable logistic regression analyses were conducted to elucidate disparities in treatment utilization and determine impact on outcome.

Results: Of 517,615 inpatient visits, there were 7,540 (1.46 %) ischemic stroke admissions, increasing from 1.14 % to 1.79 % from 2012-2021. Intravenous thrombolysis significantly decreased from 14.4 % to 9.8 % while endovascular thrombectomy significantly increased from 0.8 % to 10.5 %. Both intravenous thrombolysis and endovascular thrombectomy increased odds of discharge home and modified Rankin Scale 0-2, and thrombectomy decreased odds of expired/hospice. After adjusting for covariates, decreased odds of thrombectomy was associated with Medicaid insurance (Odds Ratio [95 % Confidence Interval] 0.55 [0.32-0.93]), age 80+ (0.49 [0.35-0.69]), prior stroke (0.49 [0.31-0.77]), and diabetes mellitus (0.55 [0.39-0.79]), while low median household income (<$80,000/year) increased odds of no acute treatment (1.34 [1.16-1.56]). No sex or racial disparities were observed. Medicaid and low-income were not associated with worse clinical outcomes.

Conclusions: Less endovascular thrombectomy occurred in Medicaid, older, prior stroke, and diabetic patients, while low-income was associated with no treatment. The observed socioeconomic disparities did not impact discharge outcome.

Keywords: Acute ischemic stroke; Disparities; Endovascular thrombectomy; Intravenous thrombolysis; Stroke treatment trends.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Disability Evaluation
  • Endovascular Procedures* / adverse effects
  • Endovascular Procedures* / trends
  • Female
  • Fibrinolytic Agents* / administration & dosage
  • Healthcare Disparities* / trends
  • Humans
  • Ischemic Stroke* / diagnosis
  • Ischemic Stroke* / epidemiology
  • Ischemic Stroke* / therapy
  • Male
  • Medicaid / trends
  • Middle Aged
  • Patient Discharge / trends
  • Practice Patterns, Physicians' / trends
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Thrombectomy* / adverse effects
  • Thrombectomy* / trends
  • Thrombolytic Therapy* / adverse effects
  • Thrombolytic Therapy* / trends
  • Time Factors
  • Treatment Outcome
  • United States / epidemiology

Substances

  • Fibrinolytic Agents