Abstract WMP50: Age-Specific Female-Male Disparities in Endovascular Thrombectomy Use for Acute Ischemic Stroke in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Hamidreza Saber ◽  
Amytis Towfighi ◽  
David S Liebeskind ◽  
Jeffrey L Saver
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Age Groups ◽  
Reperfusion Therapy ◽  
The United States ◽  
National Inpatient Sample ◽  
Endovascular Thrombectomy ◽  
Age Related ◽  
The Us ◽  
Age And Sex

Introduction: Studies have suggested sex-related and age-related variations in frequency of reperfusion therapy, but have been limited by constrained geographic scope, data from before the modern thrombectomy era, and incomplete exploration of sex-related differences in discrete age ranges. We therefore analyzed sex-, age-, and sex-age interaction in the frequency of endovascular thrombectomy (EVT) for acute ischemic stroke in the US National Inpatient Sample. Methods: In the National Inpatient Sample , we identified all adult ischemic stroke EVT hospitalizations from 2010-2016, using ICD-9-CM and ICD-10-CM codes. Patient age was categorized as: <50y, 50-59y, 60-69y, 70-79y and ≥80ys. Rates of use of EVT were assessed standardized to the 2010 US Census population. Results: Among 50,573 EVT hospitalizations, 50.1% were female. The number of EVTs increased from 4091 in 2010 to 12,875 in 2016. Over the entire 7y time period, a sex-age interaction was noted: 49% in <50y; 37% in 50-59y; 35% in 60-69y; 53% in 70-79y; and 66% in ≥80y. This sex-age interaction was present as well for EVT rates per 100,000 individuals in the population, with the total ratio of female to male rate of EVT per 100,000: 0.93 for in <50y; 0.52 in 50-59y; 0.58 in 60-69y; 0.91 in 70-79y; and 1.1 in ≥80y. EVT utilization rates increased substantially over time in both men and women in all age groups. However, the ratio of women to men per 100,000 receiving EVT changed for only one age range, decreasing among <50y from 0.98 in 2010 to 0.79 in 2016 (P<0.05). Conclusion: While half of all endovascular thrombectomies in the US are performed in women, there are major age-related sex-specific variations in EVT rates, with rates of EVT much lower among women than men in 50-70 age group. Determinants of these age-specific female-male disparities in EVT treatment merit detailed investigation. Figure: Age- and sex-specific female to male thrombectomy utilization rates.

Abstract WMP94: Temporal Trends in Racial, Age, and Sex-Specific Utilization of Decompressive Hemicraniectomy Among Acute Ischemic Stroke Patients in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Sai P Polineni ◽  
Fadar O Otite ◽  
Seemant Chaturvedi
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Temporal Trends ◽  
Age Groups ◽  
The United States ◽  
Decompressive Hemicraniectomy ◽  
Study Results ◽  
Over Time ◽  
Age And Sex

Background: The aim of this study is to evaluate current trends in racial, age, and sex-specific utilization of decompressive hemicraniectomy (HC) in acute ischemic stroke (AIS) patients in the United States over the last decade. Methods: All adult patients with a diagnosis of AIS were identified from the 2004-2015 Nationwide Inpatient Sample (weighted N=4,792,428) using International Classification of Diseases Ninth revision (ICD-9) codes. Proportion of patients undergoing HC in various age, race, and sex groups were ascertained using ICD-9 procedural codes. Temporal trends were mapped by year in order to track changes in utilization over time. Analysis of utilization disparities and trends within age, sex, and race subgroups was conducted via multivariate logistic regression. Results: Of all eligible AIS patients from 2004-2015, 0.25% underwent HC (.08 in 2004 to .46 in 2015). Increased utilization over time was seen in both men (.13 to .57) and women (.08 to .54), with women showing comparable odds of utilization to men [OR: 0.95 (95% CI: .87-1.04, p=0.27)]. Similarly, increased utilization trends were seen in all age groups (Figure 1) with the highest rates in the 18-39 subgroup (1.41%). Compared to trends in this younger subgroup (.43 to 2.12), patients aged 60-79 experienced a similar overall increase but at lower utilization rates (.06 to .37). Compared to white patients in multivariate models, blacks did not show significant differences in odds of HC [1.09 (.96-1.24, p=0.20)], while patients from Hispanic [1.25 (1.03-1.51, p=0.02)] and other [1.26 (1.04-1.52, p=0.02)] race-ethnic groups showed increased odds. Conclusions: From 2004-2015, hemicraniectomy rates have seen substantial increases in all age, sex, and race groups. The increasing rates of hemicraniectomies among those over age 60 suggest that there has been at least partial acceptance of DESTINY 2 study results.

scholarly journals Alcohol withdrawal is associated with poorer outcome in acute ischemic stroke

Neurology ◽  
2019 ◽  
Vol 93 (21) ◽  
pp. e1944-e1954
Author(s):  
Emmanuel O. Akano ◽  
Fadar Oliver Otite ◽  
Seemant Chaturvedi
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Acute Ischemic Stroke ◽  
Alcohol Withdrawal ◽  
Age Groups ◽  
The United States ◽  
Medical Complications ◽  
National Inpatient Sample ◽  
Mortality Cost ◽  
Multivariable Adjustment

ObjectiveTo determine the association between alcohol abuse (AA) and alcohol withdrawal (AW) with acute ischemic stroke (AIS) outcomes.MethodsAll adult AIS admissions in the United States from 2004 to 2014 were identified from the National Inpatient Sample (weighted n = 4,438,968). Multivariable-adjusted models were used to evaluate the association of AW with in-hospital medical complications, mortality, cost, and length of stay in patients with AIS.ResultsOf the AA admissions, 10.6% of patients, representing 0.4% of all AIS, developed AW. The prevalence of AA and AW in AIS increased by 45.2% and 40.0%, respectively, over time (p for trend <0.001). Patients with AA were predominantly men (80.2%), white (65.9%), and in the 40- to 59-year (44.6%) and 60- to 79-year (45.6%) age groups. After multivariable adjustment, AIS admissions with AW had >50% increased odds of urinary tract infection, pneumonia, sepsis, gastrointestinal bleeding, deep venous thrombosis, and acute renal failure compared to those without AW. Patients with AW were also 32% more likely to die during their AIS hospitalization compared to those without AW (odds ratio 1.32, 95% confidence interval 1.11–1.58). AW was associated with ≈15-day increase in length of stay and ≈$5,000 increase in hospitalization cost (p < 0.001).ConclusionAW is associated with increased cost, longer hospitalizations, and higher odds of medical complications and in-hospital mortality after AIS. Proactive surveillance and management of AW may be important in improving outcomes in these patients.

Abstract 16: Racial Disparities in Clinical Outcomes and Resource Utilization in Acute Ischemic Stroke Hospitalizations in the United States: Results from the 2012 National Inpatient Sample

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Nilay Kumar ◽  
Anand Venkatraman ◽  
Neetika Garg
Keyword(s):  
Logistic Regression ◽  
Ischemic Stroke ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Acute Ischemic Stroke ◽  
Racial Minorities ◽  
National Inpatient Sample ◽  
The Us ◽  
To Receive ◽  
Total Charges

Background and objectives: There are limited data on racial differences in clinical and economic outcomes of acute ischemic stroke (AIS) hospitalizations in the US. We sought to ascertain the effect of race on AIS outcomes in a population based retrospective cohort study. Methods: We used the 2012 National Inpatient Sample (NIS), which is the largest database of inpatient stays in the US, to identify cases of AIS using ICD9-CM codes 433.01, 433.11, 433.21, 433.31, 433.81, 433.91, 434.01, 434.11, 434.91 and 437.1 in patients >=18 years of age. Cases with missing data on race were excluded (5% of study sample). Primary outcome was in-hospital mortality. Secondary outcomes included proportion receiving endovascular mechanical thrombectomy (EMT) or thrombolysis, mean inflation adjusted charges and length of stay. Linear and logistic regression was used to test differences in continuous and categorical outcomes respectively. Survey techniques were used for all analyses. Results: There were 452, 330 hospitalizations for AIS in patients >=18 years in 2012. In univariate logistic regression using race as predictor, in-hospital mortality was significantly lower for Blacks (p<0.001), Hispanics (p=0.025) and Native Americans (p=0.047) compared to Whites. However, after adjusting for age, sex, Charlson comorbidity index, EMT and thrombolysis only blacks had a significantly lower mortality compared to whites (OR 0.74, 95% CI 0.66 - 0.82, p<0.001). Black patients were less likely to receive thrombolysis (OR 0.87, 95% CI 0.79 - 0.95; p=0.003) whereas Asian or Pacific Islanders were more likely to receive thrombolysis (OR 1.20, 95% CI 1.01 - 1.44; p=0.043) compared to whites. There was no difference in rates of EMT by race (p=0.18). Total charges and length of stay were significantly higher in racial minorities compared to whites (table). Conclusions: Blacks hospitalized for AIS have significantly lower in-hospital mortality compared to whites but are significantly less likely to receive thrombolysis compared to whites. Total charges and length of stay are significantly higher for racial minorities. Future studies should investigate mechanisms of this apparent protective effect of black race on in-hospital mortality in AIS.

scholarly journals Early NT-ProBNP (N-Terminal Probrain Natriuretic Peptide) Elevation Predicts Malignant Edema and Death After Reperfusion Therapy in Acute Ischemic Stroke Patients

Stroke ◽  
2021 ◽  
Author(s):  
Xuting Zhang ◽  
Shenqiang Yan ◽  
Wansi Zhong ◽  
Yannan Yu ◽  
Min Lou
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Natriuretic Peptide ◽  
Odds Ratio ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Median Serum ◽  
The Relationship

Background and Purpose: We aimed to investigate the relationship between early NT-proBNP (N-terminal probrain natriuretic peptide) and all-cause death in patients receiving reperfusion therapy, including intravenous thrombolysis and endovascular thrombectomy (EVT). Methods: This study included 1039 acute ischemic stroke patients with early NT-proBNP data at 2 hours after the beginning of alteplase infusion for those with intravenous thrombolysis only or immediately at the end of EVT for those with EVT. We performed natural log transformation for NT-proBNP (Ln(NT-proBNP)). Malignant brain edema was ascertained by using the SITS-MOST (Safe Implementation of Thrombolysis in Stroke-Monitoring Study) criteria. Results: Median serum NT-proBNP level was 349 pg/mL (interquartile range, 89–1250 pg/mL). One hundred twenty-one (11.6%) patients died. Malignant edema was observed in 78 (7.5%) patients. Ln(NT-proBNP) was independently associated with 3-month mortality in patients with intravenous thrombolysis only (odds ratio, 1.465 [95% CI, 1.169–1.836]; P =0.001) and in those receiving EVT (odds ratio, 1.563 [95% CI, 1.139–2.145]; P =0.006). The elevation of Ln(NT-proBNP) was also independently associated with malignant edema in patients with intravenous thrombolysis only (odds ratio, 1.334 [95% CI, 1.020–1.745]; P =0.036), and in those with EVT (odds ratio, 1.455 [95% CI, 1.057–2.003]; P =0.022). Conclusions: An early increase in NT-proBNP levels was related to malignant edema and stroke mortality after reperfusion therapy.

Abstract T P137: Temporal Trends in Hospitalization for Ischemic Stroke in the United States, 2000-2010

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Nerses Sanossian ◽  
May A Kim-Tenser ◽  
Lucas Ramirez ◽  
Natalie Valle ◽  
Steven Cen ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Black Women ◽  
Temporal Trends ◽  
The United States ◽  
Population Based ◽  
Older Individuals ◽  
Hospitalization Rates ◽  
The Us ◽  
Age Adjusted Rates ◽  
Age And Sex

Background: Recent population-based studies have revealed declining ischemic stroke hospitalization rates in the US, particularly among whites, but no study has assessed recent nationwide trends in race/ethnic-, age- and sex-specific stroke hospitalization rates in the US. Aims: To assess temporal trends in race/ethnic-, age-, and sex-specific rates of hospitalization for ischemic stroke in the US. Methods: Temporal trends in hospitalization for ischemic stroke (ICD-9 codes 433.x1, 434, 436) from 2000 to 2010 were assessed among adults ≥25 years using the Nationwide Inpatient Sample. Age-, sex-, and race/ethnic-specific stroke hospitalization rates were calculated using the weighted number of hospitalizations as the numerator and the US civilian population as the denominator. Age-adjusted rates were standardized to the 2000 US Census population. Results: From 2000 to 2010, age-adjusted stroke hospitalization rates decreased from 169 to 138 per 100,000 (overall rate reduction 18.3%). The decline in stroke hospitalizations was driven by the ≥65 age group, with the sharpest decline among 65-84 year olds (Figure). Sex-specific rates showed higher age-adjusted rates in women, with a steeper reduction in women than in men (from 228 to 180 vs. 183 to 157 per 100,000). Race/ethnic-specific trends revealed that hospitalizations decreased for whites and Hispanics but increased for blacks (from 144 to 193 per 100,000 in black men and from 191 to 211 per 100,000 in black women). Discussion: Although overall stroke hospitalizations have decreased in the US, the reduction has been more pronounced among older individuals, whites and Hispanics. Renewed efforts at targeting risk factor control among blacks and middle-aged individuals may be warranted. Figure 1.

Abstract P85: Impact of Covid-19 Pandemic on Hospitalizations and Outcomes of Acute Ischemic Stroke Patients, Paul Coverdell National Acute Stroke Program (pcnasp)

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Xin Tong ◽  
Sallyann Coleman King ◽  
Erika Odom ◽  
Quanhe Yang
Keyword(s):  
Ischemic Stroke ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Reperfusion Therapy ◽  
The United States ◽  
Emergency Department Visits ◽  
National Institutes Of Health ◽  
Hospital Death ◽  
Stroke Patients ◽  
Stroke Treatment

Introduction: Studies suggest a significant reduction in emergency department visits and hospitalizations for acute ischemic stroke (AIS) during the COVID-19 pandemic in the United States. Few studies have examined AIS hospitalizations, treatments, and outcomes during the pandemic period. The present study compared the demographic and clinical characteristics of patients hospitalized with AIS before and during the COVID-19 pandemic (weeks 11-24 in 2019 vs. 2020). Method: We identified 42,371 admissions with a clinical diagnosis of AIS, from 370 participating hospitals who contributed data during weeks 11-24 in both 2019 and 2020 to the Paul Coverdell National Acute Stroke Program (PCNASP). Results: During weeks 11-24 of the COVID-19 period, AIS hospitalizations declined by 24.5% compared to the same period in 2019 (18,233 in 2020 vs. 24,138 in 2019). In 2020, the percentage of individuals aged <65 years who were hospitalized with AIS was higher compared with the same period in 2019 (34.6% vs. 32.7%, p<0.001); arriving by EMS were higher in 2020 compared with 2019 (47.7% vs. 44.8%, p<0.001). Individuals admitted with AIS in 2020 had a higher mean National Institutes of Health Stroke Scale (NIHSS) score compared with 2019 (6.7 vs. 6.3, p<0.001). In 2020, the in-hospital death rates increased by 16% compared to 2019 (5.0% vs. 4.3%, p<0.001). However, there were no differences in rates of alteplase use, achievement of door to needle in 60 minutes, or complications from reperfusion therapy between the two time periods. Conclusion: A higher percentage of younger (<65 years) individuals and more severe AIS cases were admitted to the participating hospitals during weeks 11 to 24 of the COVID-19 pandemic in 2020 compared to the same period in 2019. The AIS in-hospital death rate increased 16% during the pandemic weeks as compared to the same weeks in 2019. Additional studies are needed to examine the impacts of the COVID-19 pandemic on stroke treatment and outcomes.

Abstract WP181: Timing of Percutaneous Endoscopic Gastrostomy (PEG) for Acute Ischemic Stroke Inpatients in the United States

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
George P Albert ◽  
Benjamin P George ◽  
Adam G Kelly ◽  
David Y Hwang ◽  
Robert G Holloway
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Percutaneous Endoscopic Gastrostomy ◽  
Oldest Old ◽  
Age Groups ◽  
The United States ◽  
Nasogastric Feeding ◽  
Adult Age ◽  
Endoscopic Gastrostomy ◽  
To Receive

Background and Purpose: Stroke guidelines recommend time-limited trials of nasogastric feeding prior to placement of percutaneous endoscopic gastrostomy (PEG) tubes. We sought to describe timing of PEG placement and identify factors associated with early PEG for acute ischemic stroke. Methods: We designed a retrospective observational study to examine time to PEG for ischemic stroke admissions in the Nationwide Inpatient Sample, 2001-2011. We defined early PEG placement as 1-7 days from admission. Using multivariable regression analysis, we identified the effects of patient and hospital characteristics on time to PEG. Results: We identified 34,623 admissions receiving a PEG from 2001-2011, 53% of which received the PEG early. Among hospitals placing ≥10 PEG tubes, median time to PEG for individual hospitals ranged from 3 days to over 3 weeks (interquartile range: 6-8.5 days). Older adult age groups were associated with early PEG placement (≥85 years vs. 18-54 years: Adjusted Odds Ratio [AOR] 1.68, 95% CI 1.50-1.87). Those receiving a PEG tube and tracheostomy were less likely to receive the PEG early (vs. no tracheostomy; AOR 0.27, 95% CI 0.24-0.29), and these patients were more often younger compared to PEG only recipients ( Figure ). Those admitted to high volume hospitals were more likely to receive their PEG early (≥350 vs. <150 hospitalizations; AOR 1.26, 95% CI 1.17-1.35). Conclusions: More than half of PEG recipients received their surgical feeding tube within 7 days of admission. The oldest old, who may be the most likely to benefit from time-limited trials of nasogastric feeding, were most likely to receive a PEG early.

Abstract 29: Optimization Methodologies to Enhance Endovascular Thrombectomy Access in the United States

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Amrou Sarraj ◽  
James C Grotta ◽  
Sheryl Martin-Schild ◽  
Haris Kamal ◽  
Anjail Z Sharrief ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
The United States ◽  
Direct Access ◽  
Optimization Models ◽  
Stroke Outcome ◽  
Endovascular Thrombectomy ◽  
The Us ◽  
Timely Access ◽  
Optimization Methodology

Background: Timely access to endovascular thrombectomy (EVT) centers is vital for best stroke outcome. We map current EVT access in the US then utilize modeling to optimize it. Methods: US designated stroke centers were mapped utilizing geo-mapping and stratified into EVT or non-EVT if they reported ≥1 thrombectomy code for acute ischemic stroke in 2017 to CMS. Direct EVT access, defined as the population with the closest facility to EVT centers, was calculated from validated trauma models adapted for stroke. Current 15 and 30 min access were described nationwide and in 4 states (TX, NY, CA, IL). Two optimization models were utilized. Model A used a greedy algorithm to capture the largest population with direct access when flipping 10 non-EVT to EVT centers to maximize access. Model B used bypassing methodology to directly transport patients to EVT centers within 15 min from the closest non-EVT center. Results: Of 1941 stroke centers, 714 were EVT. Approximately 99 million/32% Americans have direct EVT access within 15 min while 111 million (36.0%) within 30 minutes (Fig 1). There were 65 (43%) EVT centers in TX with 22% current 15 min access. Flipping the top 10 population density hospitals improved access to 32%, while bypassing resulted in 46% having direct access to EVT centers (fig 2 A-B). Direct access in CA was 26% which improved to 35% with flipping and 54% by 15 min bypassing from the closest non-EVT to EVT centers. Similar results were found in NY (current 21%, flipping 39%, bypassing 50%) and IL (15%, 27% and 35%, respectively), Tab 1. Conclusion: EVT access within 15 min is limited to less than 1/3 of the US population. Optimization methodology that increase EVT centers or bypass non-EVT to the closest EVT center both showed enhanced access. Results varied by states based on the population size and density. However, bypass showed more potential for maximizing direct EVT access. National and state efforts should focus on identifying gaps and tailoring solutions to improve EVT access.

Abstract WMP8: Use, Characteristics, and Outcomes of Endovascular Thrombectomy in Acute Ischemic Stroke Patients Beyond 6 Hours of Stroke Onset in US Clinical Practice

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Lee H Schwamm ◽  
Haolin Xu ◽  
Roland Matsouaka ◽  
Shreyansh Shah ◽  
Kori Zachrison ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Acute Ischemic Stroke ◽  
Functional Outcomes ◽  
Stroke Severity ◽  
Clinical Registry ◽  
Endovascular Thrombectomy ◽  
Logistic Regression Models ◽  
The Us ◽  
Significant Covariates

Introduction: Two recent RCTs have shown benefit of endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) 6-24 h from last known well (LKW) using imaging-guided patient selection, however little is known about outcomes in contemporary non-trial settings. We assessed the frequency and outcomes of EVT beyond 6 h in the US national GWTG-Stroke clinical registry. Methods: We analyzed all AIS hospitalizations between 1/1/09 - 10/1/18 at fully participating GWTG-Stroke sites to identify 53,702 patients at 697 sites treated with EVT (± IV tPA) who had valid LKW, symptom discovery (SxD) and treatment times recorded. Hospital characteristics were analyzed at the 470 sites that treated > 10 patients during the study. Table 1 shows significant covariates (standardized differences >10%) and adjusted outcomes based on logistic regression models. Results: Treatment >6 h from LKW occurred in 33% of all EVT cases (median 4.7 h, IQR 3.3-7 h), and all were treated <6 h from SxD. The proportion of EVT cases treated >6 h from LKW varied widely across sites (median 30%, IQR 24-38%) and increased sharply in 2018 (Fig). Compared to < 6 h, patients treated >6 h differed in age, AF, arrival mode/time, stroke severity and use of anticoagulation, and presented to higher EVT volume centers. Late window EVT patients had less favorable adjusted outcomes at discharge for mortality, ambulation and disposition to home or IRF compared to <6 h patients (Table). Conclusions: EVT is frequently performed >6h, accounting for one-third of cases nationally. As adjusted functional outcomes at discharge are worse in these patients, further research is required to ensure optimal EVT outcomes in clinical practice settings

Frequency, Characteristics, and Outcomes of Endovascular Thrombectomy in Patients With Stroke Beyond 6 Hours of Onset in US Clinical Practice

Stroke ◽  
2021 ◽  
Author(s):  
Kori S. Zachrison ◽  
Lee H. Schwamm ◽  
Haolin Xu ◽  
Roland Matsouaka ◽  
Shreyansh Shah ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Acute Ischemic Stroke ◽  
The United States ◽  
Interquartile Range ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
Discharge Disposition ◽  
Get With The Guidelines

Background and Purpose: In 2018, 2 randomized controlled trials showed the benefit of endovascular thrombectomy (EVT) in acute ischemic stroke patients treated 6 to 24 hours from last known well using imaging-guided selection. However, little is known about outcomes in contemporary nontrial settings. We assessed the frequency of EVT and outcomes beyond 6 hours in the US Get With The Guidelines–Stroke clinical registry. Methods: We analyzed all acute ischemic stroke patients treated with EVT between January 1, 2009 and October, 1, 2018, at Get With The Guidelines–Stroke hospitals in the United States. We assessed trends over time in frequency of EVT beyond 6 hours, compared patient characteristics and outcomes between those treated within versus beyond 6 hours, and evaluated the associations between EVT time and outcomes. Results: We identified 53 702 patients at 697 sites treated with EVT during the study period. Treatment after 6 hours from last known well occurred in 17 720 (33%) of all 53 702 EVT cases (median 4.7 hours, interquartile range, 3.3–7 hours). The proportion of EVT cases treated after 6 hours from last known well varied widely across sites (median 30%, interquartile range, 24%–38%). Compared with patients treated within 6 hours, those treated beyond six hours were younger, less likely to have atrial fibrillation, less likely to arrive by ambulance, had lower stroke severity, were less likely to be anticoagulated, and more likely to be treated at centers with higher EVT volumes. After adjusting for patient and hospital characteristics, patients receiving EVT beyond 6 hours had less favorable in-hospital mortality, ambulation at discharge, and discharge disposition compared to those treated within 6 hours. Conclusions: EVT is frequently performed for patients with ischemic stroke after 6 hours from last known well, accounting for one-third of cases nationally, and adjusted functional outcomes at discharge are worse in these patients compared to those treated with EVT within 6 hours. Further efforts are needed for optimal EVT outcomes in clinical practice settings.

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