Abstract 139: Regional Disparities in Mechanical Thrombectomy Utilization for Treatment of Acute Ischemic Stroke in the United States

Abstract

Background: A current national priority is to understand geographic disparities in mechanical thrombectomy (MT) provision for patients with acute ischemic stroke (AIS). We examine variation in rates of MT by geographic region and urban-rural areas to identify utilization disparities across the United States. Methods: The state-specific annual incidence of AIS in 2019 was determined using data from the Global Burden of Disease Collaborative Network. We determined the number of patients who were admitted with AIS due to thrombosis or embolism of anterior circulation arteries and those who received MT in a particular region/state based on the State Inpatient Database of NIS. The National Inpatient Sample data were used to create national weighted estimates of the size of subject populations, age at admission, length of stay, and discharge status. Results: In the United States, approximately 28,165 MT were performed in 2019, representing 4% of the AIS population. In large central metropolitan areas, the proportion of thrombectomies performed to the AIS patient population was significantly higher than the national estimate (4.34%, P < 0.001); small metropolitan areas and rural settings (micropolitan and noncore) had significantly lower proportions of MT-treated patients with 3.2% and 2.9%, respectively (P < 0.001), when compared with the national estimate. West region had significantly higher proportions of MT-treated patients with 4.3%, compared with the national estimate (P < 0.001), whereas South region had significantly lower proportions with 3.8% (P < 0.001). Conclusions: We found prominent regional disparities in the utilization rates of MT in acute ischemic stroke patients in the United States, which may have implications for Regional Stroke Destination Plans in Rural, Suburban, and Urban Communities.