Get With the Guidelines-Stroke Registry Analyzes Endovascular Stroke Therapy

April 2, 2015—In Stroke, Bijoy K. Menon, MD, et al published a study on trends in endovascular therapy and clinical outcomes within the nationwide Get With the Guidelines-Stroke registry (2015;46:989–995). The investigators reviewed data from the Get With the Guidelines-Stroke hospitals from April 1, 2003, to June 30, 2013, to determine hospital and patient characteristics associated with the use of endovascular therapy for acute ischemic stroke and to analyze trends in clinical outcomes.

The investigators found that the use of endovascular therapy increased modestly in the United States from 2003 to 2012 and decreased in 2013. Clinical outcomes improved notably from 2010 to 2013, which coincides with greater operator experience and newer thrombectomy devices.

As summarized in Stroke, the investigators looked at trends in the use of endovascular therapy in hospitals, the number of hospitals providing this therapy, and clinical outcomes. Hospital and patient characteristics associated with endovascular therapy use were also analyzed.

The investigators reported that 454 of 1,087 hospitals provided endovascular therapy to one or more patients during the study period. From 2003 to 2012, the proportion of hospitals providing endovascular therapy increased by 1.6% per year, with a modest drop in 2013. Utilization of endovascular therapy increased from 0.7% to 2%, with a modest drop to 1.9% in 2013. The overall rate of symptomatic intracerebral hemorrhage among patients treated with endovascular therapy was 9.7%. 

In multivariable analyses, patient outcomes after endovascular therapy improved over time, with reductions in in-hospital mortality from 29.6% in 2004 to 16.2% in 2013.

From late 2010 to 2013, there was a reduction in symptomatic intracerebral hemorrhage from 11% to 5%, an increased independent ambulation at discharge from 24.5% to 33%, and discharge home from 17.7% to 26.1%. Trends for these outcomes persisted in the analyses when adjusted for the baseline National Institutes of Health Stroke Scale, stated the investigators in Stroke.