Journal of Stroke & Cerebrovascular Diseases最新文献

Objectives: Endovascular thrombectomy (EVT) has become an established treatment for eligible acute ischemic stroke (AIS) patients, but data on mortality trends and the association between procedural volume and outcomes in the United States is limited.

Materials and methods: This retrospective study analyzed data from the Nationwide Readmissions Database (NRD) to investigate trends in EVT utilization, outcomes, and the relationship between hospital procedural volume and inpatient mortality for AIS admissions between 2016-2020. Patients undergoing EVT were identified using ICD-10 procedure codes. Hospitals were categorized into quintiles based on EVT volumes, and mortality rates compared across quintiles. Multivariable regression identified predictors of mortality.

Results: Of 2,535,777 AIS admissions, 90,110 (3.6%) underwent EVT (median age of 70 and 50% female in both groups). EVT utilization increased from 2.8% in 2016 to 3.9% in 2020 (p<0.001). Patients receiving EVT had higher prevalence of atrial fibrillation and coronary artery disease but lower rates of hyperlipidemia and tobacco use. Inpatient mortality was higher with EVT (13% vs 4%, p<0.001) but declined from 16% in 2016-2017 to 12% in 2020 (p<0.001). Hemiparalysis and atrial fibrillation were associated with higher EVT likelihood. Mortality decreased with higher hospital EVT volume. After adjustment, higher procedural centers were associated with lower mortality.

Conclusion: EVT utilization for AIS increased nationally from 2016-2020 while associated mortality declined. Higher hospital procedural volumes were associated with lower mortality.

Background: Pressure on carotid artery by hyoid bone may influence plaque formation. We studied CTA-based hyoid-carotid anatomical interaction and its relationship with carotid stenosis degree and stenosis-related stroke.

Methods: We retrospectively analysed pre-operative CTA of 205 consecutive adults having undergone carotid endarterectomy (CEA) for asymptomatic or symptomatic stenosis. Radiological measurements were: degree stenosis, hyoid-carotid distance, carotid position in regard to hyoid, and hyoid morphology.

Results: In total, 410 carotids (including 114 symptomatic and 296 asymptomatic stenotic and non-stenotic carotids) from 205 CEA patients (median age 74, 72% men) were analysed. Median carotid stenosis was 61% (70% for symptomatic and 51% for asymptomatic carotids, p<0.0001; 70% for CEA and 30.5% for non-CEA carotids, p<0.0001). None of the other radiological parameters differed between asymptomatic/symptomatic carotids, between non-CEA/CEA carotids, or between asymptomatic/symptomatic patients. Median hyoid-carotid distance was 4.3mm, with 82% of carotids in posterolateral quadrant position in regard to the hyoid. There was no correlation between stenosis degree and hyoid-carotid distance (rho=-0.039), hyoid width (rho=-0.079), length (rho=0.007) or circumferential length (rho=-0.005), and stenosis degree was comparable between different carotid position quadrants (p=0.51).

Conclusions: Hyoid-carotid distance, hyoid position and morphology are not correlated with the degree of carotid stenosis or symptomatic carotid stenosis.

Clinical trial registration-url: http://www.

Clinicaltrials: gov: Unique identifier: NCT05349526.

Introduction: There are no guideline recommendations for DSA in the ischemic stroke work-up. We studied the rate of DSA in ischemic stroke, the recent time-trend, hospital variation and associated factors.

Methods: This is a retrospective cross-sectional study among Medicare fee-for-service beneficiaries with ischemic stroke admitted between 2016 and 2020 in the United States. ICD-10 codes were used to determine ischemic stroke diagnosis and procedure codes for thrombectomy and DSA. Hospital trends and factors associated with DSA performance were analyzed in hospitals with DSA capacity.

Results: 7.373 (0.7%) of the 1,085,644 ischemic stroke patients, had a DSA for diagnostic purposes. In the patients that were admitted to a hospital with DSA facility, the following factors showed the strongest association with DSA: younger age (aOR=0.81 [95% confidence interval (CI):0.81-0.83]), thrombectomy rate in that hospital (aOR=2549 [95%CI:610-10663]), transfer (aOR=1.41[95%CI:1.34-1.50]) and carotid disease (aOR=5.8 [95%CI:5.6-6.1]). There was large variation in the hospital DSA rate, varying from 0.07% to 11.1%. Of the variance of DSA rates, 15% was attributed to the residual effect hospital propensity to perform DSA. The top decile of hospitals with the highest DSA rate, performed DSA's in >2.3% of patients, compared to the 0.6% median. There was no change in DSA rates over time.

Conclusion: DSA is used infrequently in acute ischemic stroke patients and did not change between 2016 to 2020. Hospital variation in DSA use was however large, and not solely explained by patient and facility factors.