Abstract
Background
Endovascular thrombectomy (ET) has become the standard of stroke care for large vessel
occlusion acute ischemic stroke (AIS) involving the anterior circulation. With continued
eligibility expansion, the demand for neuro-intervention is growing. Current estimates
indicate inadequate supply of interventionalists. However, there is limited data describing
the number of interventionalists per hospital in the US, and correlations with outcomes.
Methods
We used Medicare 100% sample datasets and included all AIS admissions from 2018 to
2019, using validated International Classification of Diseases, 10th Revision, Clinical
Modification codes to identify AIS and comorbidities. We utilized National Provider
Identifier codes to identify distinct interventionalists at the hospital. We examined
outcomes at the hospital level, including percent of AIS treated with thrombolysis,
percent of AIS with inpatient mortality, percent of AIS with discharge home, and percent
of AIS with death within 30 days.
Results
Among 471,427 AIS admissions, 16,253 received ET over the 2-year period of the study.
Only 683 of 4576 AIS-treating institutions provided ET (14.9%). These ET centers most
frequently only had one interventionalist performing ET and were clustered in large
metropolitan areas with high AIS volumes. As AIS volumes, ET volumes, and mean NIHSS
scores increased, so did the number of interventionalists. With each additional interventionalist,
there was an increased likelihood of poor outcomes including inpatient mortality,
discharge home, and 30-day mortality.
Conclusions
We confirmed a relative lack of neuro-interventionalists among US hospitals, with
a concentration of interventionalists in urban, high-volume centers. The greater likelihood
of poor outcomes associated with increasing number of interventionalists is likely
due to increasing complexity and severity of cases at high-volume ET centers, but
further study is needed.
Key Words
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Article info
Publication history
Published online: December 13, 2022
Accepted:
December 10,
2022
Received in revised form:
November 10,
2022
Received:
October 1,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106943
Copyright
© 2022 Elsevier Inc. All rights reserved.
