title: [Availability of mechanical thrombectomy for acute stroke : Analysis of the health care reality in Germany].
abstract: BACKGROUND
  Mechanical thrombectomy (MT) has become an evidence-based therapy for stroke patients with proximal vessel occlusion of the anterior cerebral circulation. Nationwide availability of MT for all eligible patients within the shortest possible time window is a major challenge.
  
  
  OBJECTIVE
  Nationwide analysis of the rates of systemic thrombolysis (STL) and MT in Germany according to region and hospital-based evaluation.
  
  
  METHODS
  The evaluation involved data analysis of the diagnosis-related groups (DRG) statistics and structured quality reports of hospitals for 2010 and 2014. The rates and changes of STL and MT were evaluated in the 413 German districts with reference to the corresponding case number of patients with acute ischemic stroke.
  
  
  RESULTS
  Nationwide recanalization treatment rates increased from 2010 to 2014 both for STL (from 8.0% to 11.6%) and MT (from 0.7% to 2.3%). High variations were observed depending on the patient's place of residence (STL = 3.4-36.7%, MT = 0-7.4%). In 2014 a total of 5526 MT were coded in a total of 244,757 ischemic strokes. A total of 134 hospitals with more than 2 MT per year were identified; however, 21% of the nationwide MTs were performed in only 7 hospitals with more than 100 MT/year. In 308 (75%) of the 413 districts, not a single MT was performed.
  
  
  CONCLUSIONS
  Due to a narrow net of certified stroke units with nationwide availability of STL, excellent structural conditions for treatment of acute stroke patients are already established in Germany. With regard to the nationwide availability of MT, there is still a need for optimization. Despite the increasing number of hospitals providing MT as an emergency procedure, a trend toward large intervention centers with supraregional catchment areas can be observed.
authors.affiliation: Klinik für Neurologie, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland. christos.krogias@rub.de.|Neurovaskuläres Netz Ruhr, Ruhrgebiet, Deutschland. christos.krogias@rub.de.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland. christos.krogias@rub.de.
authors.forename: C
authors.initials: C
authors.lastname: Krogias
authors.affiliation: drg market Osnabrück, Osnabrück, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
authors.forename: D
authors.initials: D
authors.lastname: Bartig
authors.affiliation: Klinik für Neurologie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-Universität Bochum, Bochum, Deutschland.|Neurovaskuläres Netz Ruhr, Ruhrgebiet, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Kitzrow
authors.affiliation: Klinik für Radiologie und Neuroradiologie, Sana Kliniken Duisburg, Duisburg, Deutschland.|Neurovaskuläres Netz Ruhr, Ruhrgebiet, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Brassel
authors.affiliation: Klinik für Neurologie, St. Josef Krankenhaus Moers, Moers, Deutschland.|Neurovaskuläres Netz Ruhr, Ruhrgebiet, Deutschland.
authors.forename: E W
authors.initials: EW
authors.lastname: Busch
authors.affiliation: Klinik für Neurologie, Sana Kliniken Duisburg, Duisburg, Deutschland.|Neurovaskuläres Netz Ruhr, Ruhrgebiet, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Nolden-Koch
authors.affiliation: Klinik für Neurologie, Klinikum Dortmund gGmbH, Dortmund, Deutschland.|Neurovaskuläres Netz Ruhr, Ruhrgebiet, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
authors.forename: G
authors.initials: G
authors.lastname: Reimann
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Essen, Essen, Deutschland.|Neurovaskuläres Netz Ruhr, Ruhrgebiet, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
authors.forename: C
authors.initials: C
authors.lastname: Weimar
authors.affiliation: Klinik für Neurologie, Alfried Krupp Krankenhaus Essen, Essen, Deutschland.|Neurovaskuläres Netz Ruhr, Ruhrgebiet, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Weber
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Knappschaftskrankenhaus, Ruhr-Universität Bochum, Bochum, Deutschland.|Neurovaskuläres Netz Ruhr, Ruhrgebiet, Deutschland.|Arbeitsgemeinschaft Nordwestdeutscher Stroke Zirkel e. V., Bochum, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Eyding
mesh_terms: D000208:Acute Disease; D002544:Cerebral Infarction / Q000453:epidemiology / Q000628:therapy*; D003430:Cross-Sectional Studies; D005858:Germany; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006757:Hospital Units / Q000706:statistics & numerical data; D006801:Humans; D020767:Intracranial Thrombosis / Q000453:epidemiology / Q000628:therapy*; D020521:Stroke / Q000453:epidemiology / Q000628:therapy*; D017131:Thrombectomy / Q000706:statistics & numerical data*; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*
keywords: Districts; Federal states; Independent city; Network; Thrombolysis