Introduction: In 2015, mechanical thrombectomy (MT) with stent-retrievers became a standard of care treatment for acute ischemic stroke (AIS). Data on the impact of stent-retrievers on clinical outcomes in non-trial settings is limited. This study examines the association between the transition from first generation devices to stent-retrievers and clinical outcomes in a large inpatient sample.
Methods: We used data from the 2010 - 2013 National Inpatient Sample for patients (n=3553) with a diagnosis of AIS using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9 CM) diagnosis codes who underwent MT using ICD-9-CM procedure code of 39.74. Patients in the 2010-2011 time period (Period 1) were categorized as first generation device patients and patients in the 2012-2013 time period (Period 2) were categorized as second generation device patients. Outcomes were in-hospital mortality (alive/dead), discharge disposition (favorable/unfavorable), and length of stay (normal/prolonged). Weighted binary logistic regression models adjusting for patient and hospital level factors were developed.
Results: The number of procedures increases from 679 in 2010 to 1128 in 2013. In Period 1, 1443 patients were treated with MT and in Period 2, 2110 patients were treated with MT. In the adjusted model, compared to patients in Period 1, patients in Period 2 were 31% less likely to be deceased (aOR = 0.69; 95% CI = 0.58-0.83) and 22% less likely to be discharged to an unfavorable location (aOR = 0.78; 95% CI = 0.64-0.95). There was no statistically significant association between treatment period and length of stay (aOR = 0.95; 95% CI = 0.82-1.10).
Conclusion: Patients that had an MT performed during the stent-retrievers years were less likely to expire and be discharged to an unfavorable location than patients in the first generation device years. This confirms the past literature on the beneficial effects of a second generation of stent-retrievers in the treatment of acute ischemic stroke in a real world setting.