title: Case volumes of intra-arterial and intravenous treatment of ischemic stroke in the USA.
abstract: OBJECTIVE
  Ischemic stroke is a major cause of disability and death in the USA. Intravenous tissue plasminogen activator (t-PA) remains underutilized. With the development of newer intra-arterial reperfusion therapies, there is increased opportunity to address the more devastating large-vessel occlusions. We seek to identify the numbers of patients with stroke treated with intravenous and intra-arterial therapies, as well as to estimate the potential number of intra-arterial cases in the foreseeable future.
  
  
  METHODS
  We performed a literature search to determine case volumes of intravenous t-PA use. We extrapolated the current case volume of intra-arterial stroke therapies from the numbers of cases in which the Merci retrieval device was used. In order to estimate the potential numbers of intra-arterial stroke cases, we characterized the percentage of patients with stroke who received intra-arterial therapy at two leading stroke centers. We applied these percentages to the numbers of patients with stroke seen at the top 100, 200 and 500 stroke centers by volume.
  
  
  RESULTS
  The rate of intravenous t-PA use is 2.4-3.6%, resulting in 15 000-22 000 cases/year in the USA. The estimated case volume of intra-arterial therapies is 3500-7200 in 2006. Based on data from St. Luke's Brain and Stroke Institute and Massachusetts General Hospital, approximately 5-20% of patients with ischemic stroke can be treated with intra-arterial therapies. Extrapolating this to the top 500 stroke centers by volume, the potential number of intra-arterial cases in the USA is 10 400-41 500/year.
  
  
  CONCLUSIONS
  Based on the current numbers of intra-arterial cases, our theoretical model identifies a potential for significant growth of this stroke therapy.
authors: Department of Neuroradiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors: J A
authors: JA
authors: Hirsch
authors: A J
authors: AJ
authors: Yoo
authors: R G
authors: RG
authors: Nogueira
authors: L A
authors: LA
authors: Verduzco
authors: L H
authors: LH
authors: Schwamm
authors: J C
authors: JC
authors: Pryor
authors: J D
authors: JD
authors: Rabinov
authors: R G
authors: RG
authors: González
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007269:Injections, Intra-Arterial; D007275:Injections, Intravenous; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology / Q000601:surgery; D017131:Thrombectomy / Q000706:statistics & numerical data*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator