Abstract 328: Accessibility to Mechanical Thrombectomy in the United States: A 2018–2022 Trend Analysis

Abstract

Introduction Utilization of mechanical thrombectomy (MT) in acute ischemic stroke patients with large vessel occlusion (LVO) in the United States (US) has expanded in eligibility over the last decade, but the actual trend of availability compared to volume of stroke is unknown. This study aims to quantify the annual volume of MT compared to the annual volume of stroke in the US from 2018 to 2022 and divisional‐based accessibility to MTs in 2022. Methods We utilized the 2018‐2022 National Inpatient Sample (NIS) to conduct a serial cross‐sectional study. We utilized a conservative and a more liberal International Classification of Diseases (ICD) coding algorithm to estimate the annual number of hospitalizations for cerebrovascular diseases in the United States over the study period. We estimated the number of LVO strokes occurring annually as 20% of the total annual stroke volume and used a constellation of ICD‐10 codes corresponding to those for MT to define MT hospitalizations. We computed annual weighted MT volumes by applying relevant NIS discharge weights to the obtained volumes, and we computed revascularization proportions in various census divisions using the annual stroke volume in each division as the denominator. Results From 2018 to 2022, the volumes of MT have continuously risen each year to 43,015 cases. The proportion of sex and age groups of the patients treated with MT remains unchanged, with females receiving treatment ranging from 49.1% to 50.3%. The major age group for which the procedure was being done is patients aged 60 to 79 years, with 48.4% to 50.3% in this age group, followed by the age group 80 years and older (26.1%‐26.9%), then the age group 40 to 59 years (19.9%‐20.8%). In 2022, the top three divisions with the highest MT volumes are South Atlantic (9,770 cases), followed by Pacific (6,175 cases), and East North Central (6,035 cases). From the total number of patients admitted due to acute ischemic stroke, which was 713,180 patients, the rates of MT were calculated for their specific division. The top three divisions with the highest MT rates for acute ischemic stroke were Mountain (6.66%), followed by Middle Atlantic (6.47%) and West North Central (6.45%). Conclusion Only just over forty thousand MTs were done in the US in 2022. Given an estimated annual LVO volume of 140,000 to 200,000 over the same time period, only one‐third of all LVO strokes may be receiving treatment. Improvement in the stroke systems of care is needed to improve MT access for all patients.

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