Introduction: Endovascular therapy is the current standard of care for eligible patients with acute ischemic stroke (AIS) due to large artery anterior circulation occlusion. All patients with moderate to severe symptoms and a treatable occlusion should be considered for EVT. We sought to evaluate temporal trends in the rates of EVT use at the two large academic stroke centers in the US.
Methods: Using GWTG stroke registry data from MGH and UAMS, we analyzed 7,505 consecutive stroke admissions from 01/09 - 06/16. We evaluated the temporal trends in patient characteristics, clinical care and timeliness of care among the population of all patients and those treated within 6 or 12 hr from last known well (LKW).
Results: Of the total 7,505 AIS patients, 3,722 (49%) presented within 12 hr of LKW and 2,716 (36%) within 6 hr. There were a total of 404 EVT performed at the two centers (334 ≤ 12 hr and 304 ≤ 6 hr). We observed a significant increase in the rates of EVTs performed over the past eight years with a near doubling of EVT and the sharpest rise in 2013-14 after the MR CLEAN results were presented (Figure 1). While patient characteristics remained largely unchanged, care got faster with significant decreases in time from door to CT, to tPA and to EVT. In addition, rates of drip and ship tPA cases increased from 26% to 39%.
Conclusion: At two major academic stroke centers, rates of EVT increased sharply after high quality evidence supporting its use were presented. An ongoing national emphasis on improving door to tPA times appears to be working, and to be associated with improvements in EVT delivery as well. Further work is needed to improve prehospital triage and inhospital delays to increase access to rapid EVT.