Patient Outcomes With Endovascular Embolectomy Therapy for Acute Ischemic Stroke A Study of the National Inpatient Sample: 2006 to 2008
ABSTRACT Maturing techniques have spurred widespread implementation of endovascular embolectomy therapy for ischemic stroke. We evaluated a large administrative database to determine outcomes in patients treated with endovascular embolectomy in the general population.
Using the National Inpatient Sample, we evaluated outcomes of patients treated for acute ischemic stroke in the United States from 2006 to 2008. Patients who had an ischemic stroke and underwent endovascular clot retrieval were identified. Morbidity, defined as "discharge to long-term facility," and mortality were evaluated as a function of patient age and of concomitant thrombolytic agent administration.
For 2006 to 2008, a total of 3864 patients received endovascular clot retrieval with 266 (6.9%) patients in 2006, 800 (20.7) patients in 2007, and 2798 (72.4%) patients in 2008. The discharge to a long-term facility rate was 51.3% (1983 of 3864). The in-hospital mortality rate was 24.3% (940 of 3864). For patients <65 years old, the rate of in-hospital death was 17.1% (283 of 1658) as compared with a rate of 29.7% (656 of 2206) for patients ≥65 years old (P<0.0001). The rate of discharge to a long-term facility was 47.6% (789 of 1658) for patients <65 years old and 54.1% (1193 of 2206) for patients ≥65 years old (P<0.0001). The rate of intracranial hemorrhage was 15.5% without concomitant thrombolysis and 20.0% with concomitant thrombolysis (P=0.0009).
Rates of morbidity and mortality remain high for patients with acute stroke, even in the setting of endovascular embolectomy. Advanced age portends a worse outcome and patients treated with concomitant use of thrombolytic agent had higher rates of intracranial hemorrhage than those without such therapy.
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ABSTRACT: Acute ischemic stroke continues to be one of the leading causes of disability and death and is a financial burden to an already taxed health care system. Much research and investigation has been carried out over the past decade on various recanalization devices aimed at restoring cerebral blood flow. Despite the rapidly improving technical abilities of these devices, it has been difficult to demonstrate corresponding improved clinical outcomes. This article will describe the application of the most recent generation of these devices and briefly discuss the ongoing discrepancy between these technical achievements and stroke outcomes.Methodist DeBakey cardiovascular journal 04/2014; 10(2):105-110. DOI:10.14797/mdcj-10-2-105
- American Journal of Neuroradiology 09/2011; 32(10):1769-70. DOI:10.3174/ajnr.A2783 · 3.68 Impact Factor
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ABSTRACT: It is important to know the costs of hospitalization for patients undergoing endovascular embolectomy so that comparisons can be made with payments to hospitals. Using the National Inpatient Sample, we evaluated the costs of hospitalization for patients treated with endovascular embolectomy in the United States from 2006 to 2008. The primary end point examined in this study was total hospital costs, and these were correlated with clinical outcome. A total of 3864 patients received endovascular embolectomy. A total of 1649 patients were <65 years old and 2205 patients were ≥65 years old. Median hospital costs in 2008 dollars were $36,999 (interquartile range, $26,662-$56,405) for patients with good outcome, $50,628 (interquartile range, $33,135-$76,063) for patients with severe disability, and $35,109 (interquartile range, $25,053-$62,621) for patients with mortality. Hospitalization costs for patients treated with endovascular embolectomy are rather high, probably due to the serious nature of their illness. Medicare payments have not been adequate reimbursement for these hospitalizations.Stroke 11/2011; 42(11):3271-3. DOI:10.1161/STROKEAHA.111.618405 · 6.02 Impact Factor