title: Trends in endovascular therapy and clinical outcomes within the nationwide Get With The Guidelines-Stroke registry.
abstract: OBJECTIVE
  We sought to determine hospital and patient characteristics associated with the use of endovascular therapy for acute ischemic stroke and to analyze trends in clinical outcome.
  
  
  METHODS
  Data were from Get With The Guidelines-Stroke hospitals from April 1, 2003, to June 30, 2013. We looked at trends in number of hospitals providing endovascular therapy, the use of endovascular therapy in these hospitals and clinical outcomes. We analyzed hospital and patient characteristics associated with endovascular therapy use.
  
  
  RESULTS
  Of 1087 hospitals, 454 provided endovascular therapy to ≥1 patient in the study period. From 2003 to 2012, proportion of hospitals providing endovascular therapy increased by 1.6% per year (from 12.9% to 28.9%; P<0.0001), with a modest drop to 23.4% in 2013. Utilization of endovascular therapy increased from 0.7% to 2% (P<0.001) with a modest drop to 1.9% in 2013. The overall rate of symptomatic intracerebral hemorrhage among endovascular therapy treated patients was 9.7%. In multivariable analyses, patient outcomes after endovascular therapy improved over time, with reductions in in-hospital mortality (29.6% in 2004 to 16.2% in 2013; P=0.002); and from late 2010, reduction in symptomatic intracerebral hemorrhage (11% in 2010 to 5% in 2013; P<0.0001), increased independent ambulation at discharge (24.5% in 2010 to 33% in 2013; P<0.0001) and discharge home (17.7% in 2010 to 26.1% in 2013; P<0.0001). Trends for these outcomes persist in the analyses adjusted for baseline National Institutes of Health Stroke Scale.
  
  
  CONCLUSIONS
  The use of endovascular therapy increased modestly nationally from 2003 to 2012 and decreased in 2013. Clinical outcomes improved notably from 2010 to 2013, coincident with more experience and newer thrombectomy devices.
authors: From the Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute (B.K.M., M.G., E.E.S.) and Department of Radiology (B.K.M., M.G., E.E.S.), University of Calgary, Calgary, Alberta, Canada; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.N.); Department of Neurology, Northwestern University, Evanston, IL (S.P.); Duke Clinical Research Institute, Duke University, Durham, NC (L.L., Y.X., A.F.H.); and Department of Neurology, Massachusetts General Hospital, Boston, MA (L.S.). Bijoy.Menon@Albertahealthservices.ca.
authors: Bijoy K
authors: BK
authors: Menon
authors: From the Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute (B.K.M., M.G., E.E.S.) and Department of Radiology (B.K.M., M.G., E.E.S.), University of Calgary, Calgary, Alberta, Canada; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.N.); Department of Neurology, Northwestern University, Evanston, IL (S.P.); Duke Clinical Research Institute, Duke University, Durham, NC (L.L., Y.X., A.F.H.); and Department of Neurology, Massachusetts General Hospital, Boston, MA (L.S.).
authors: Jeffrey L
authors: JL
authors: Saver
authors: From the Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute (B.K.M., M.G., E.E.S.) and Department of Radiology (B.K.M., M.G., E.E.S.), University of Calgary, Calgary, Alberta, Canada; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.N.); Department of Neurology, Northwestern University, Evanston, IL (S.P.); Duke Clinical Research Institute, Duke University, Durham, NC (L.L., Y.X., A.F.H.); and Department of Neurology, Massachusetts General Hospital, Boston, MA (L.S.).
authors: Mayank
authors: M
authors: Goyal
authors: From the Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute (B.K.M., M.G., E.E.S.) and Department of Radiology (B.K.M., M.G., E.E.S.), University of Calgary, Calgary, Alberta, Canada; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.N.); Department of Neurology, Northwestern University, Evanston, IL (S.P.); Duke Clinical Research Institute, Duke University, Durham, NC (L.L., Y.X., A.F.H.); and Department of Neurology, Massachusetts General Hospital, Boston, MA (L.S.).
authors: Raul
authors: R
authors: Nogueira
authors: From the Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute (B.K.M., M.G., E.E.S.) and Department of Radiology (B.K.M., M.G., E.E.S.), University of Calgary, Calgary, Alberta, Canada; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.N.); Department of Neurology, Northwestern University, Evanston, IL (S.P.); Duke Clinical Research Institute, Duke University, Durham, NC (L.L., Y.X., A.F.H.); and Department of Neurology, Massachusetts General Hospital, Boston, MA (L.S.).
authors: Shyam
authors: S
authors: Prabhakaran
authors: From the Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute (B.K.M., M.G., E.E.S.) and Department of Radiology (B.K.M., M.G., E.E.S.), University of Calgary, Calgary, Alberta, Canada; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.N.); Department of Neurology, Northwestern University, Evanston, IL (S.P.); Duke Clinical Research Institute, Duke University, Durham, NC (L.L., Y.X., A.F.H.); and Department of Neurology, Massachusetts General Hospital, Boston, MA (L.S.).
authors: Li
authors: L
authors: Liang
authors: From the Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute (B.K.M., M.G., E.E.S.) and Department of Radiology (B.K.M., M.G., E.E.S.), University of Calgary, Calgary, Alberta, Canada; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.N.); Department of Neurology, Northwestern University, Evanston, IL (S.P.); Duke Clinical Research Institute, Duke University, Durham, NC (L.L., Y.X., A.F.H.); and Department of Neurology, Massachusetts General Hospital, Boston, MA (L.S.).
authors: Ying
authors: Y
authors: Xian
authors: From the Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute (B.K.M., M.G., E.E.S.) and Department of Radiology (B.K.M., M.G., E.E.S.), University of Calgary, Calgary, Alberta, Canada; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.N.); Department of Neurology, Northwestern University, Evanston, IL (S.P.); Duke Clinical Research Institute, Duke University, Durham, NC (L.L., Y.X., A.F.H.); and Department of Neurology, Massachusetts General Hospital, Boston, MA (L.S.).
authors: Adrian F
authors: AF
authors: Hernandez
authors: From the Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute (B.K.M., M.G., E.E.S.) and Department of Radiology (B.K.M., M.G., E.E.S.), University of Calgary, Calgary, Alberta, Canada; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.N.); Department of Neurology, Northwestern University, Evanston, IL (S.P.); Duke Clinical Research Institute, Duke University, Durham, NC (L.L., Y.X., A.F.H.); and Department of Neurology, Massachusetts General Hospital, Boston, MA (L.S.).
authors: Gregg C
authors: GC
authors: Fonarow
authors: From the Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute (B.K.M., M.G., E.E.S.) and Department of Radiology (B.K.M., M.G., E.E.S.), University of Calgary, Calgary, Alberta, Canada; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.N.); Department of Neurology, Northwestern University, Evanston, IL (S.P.); Duke Clinical Research Institute, Duke University, Durham, NC (L.L., Y.X., A.F.H.); and Department of Neurology, Massachusetts General Hospital, Boston, MA (L.S.).
authors: Lee
authors: L
authors: Schwamm
authors: From the Calgary Stroke Program, Department of Clinical Neurosciences, Hotchkiss Brain Institute (B.K.M., M.G., E.E.S.) and Department of Radiology (B.K.M., M.G., E.E.S.), University of Calgary, Calgary, Alberta, Canada; Department of Neurology (J.L.S.) and Division of Cardiology (G.C.F.), University of California, Los Angeles; Department of Neurology, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA (R.N.); Department of Neurology, Northwestern University, Evanston, IL (S.P.); Duke Clinical Research Institute, Duke University, Durham, NC (L.L., Y.X., A.F.H.); and Department of Neurology, Massachusetts General Hospital, Boston, MA (L.S.).
authors: Eric E
authors: EE
authors: Smith
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000706:statistics & numerical data; D057510:Endovascular Procedures / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data / Q000639:trends*; D010351:Patient Discharge / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012042:Registries / Q000706:statistics & numerical data*; D020521:Stroke / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology
keywords: endovascular procedures; outcome assessment; stroke