Introduction: Given progressive advances in devices and technique, we aimed to investigate nationwide, temporal trends in the use and outcomes of endovascular intra-arterial therapy (IAT) for stroke with respect to technological changes.

Methods: Patients with hospital discharge diagnoses of acute ischemic stroke from 2004-2012 were identified from the Nationwide Inpatient Sample (NIS). The rates of endovascular IAT and in-hospital mortality over three time periods: 2004-2007 (post-MERCI), 2008-2011 (post-Penumbra), and 2012 (post-Solitaire), were evaluated stratified by hospital and patient characteristics.

Results: Endovascular IAT has steadily increased from 2004 (0.05%) to 2012 (1.57%). The overall in-hospital mortality in patients treated with endovascular IAT decreased significantly from 2004 (31.8%) to 2012 (17.1%) despite increases in the mean age (p<0.001) and Charlson Comorbidity Index (CCI) of these patients (p<0.001). The mortality decrease was significant from post-MERCI (25.3%), to post-Penumbra (20.1%), to post-Solitaire period (17.1%). In subgroup analyses based on age, the mortality decrease from 3 periods of technological changes was significant for patients older than 65 (27.3% vs. 23.4% vs. 16.8%, p<0.001), and trending towards significance for those younger than 65 (24.0% vs. 17.2% vs. 17.4%, p=0.07).

Conclusions: Endovascular IAT utilization for acute ischemic stroke has increased significantly from 2004 to 2012. Despite significant increase in mean patient age and comorbidities, mortality associated with endovascular IAT has decreased from post-MERCI (2004-2007), post-Penumbra (2008-2011), to post-Solitaire (2012) era, significantly in patients between 65 and 80 years of age.

Patient Care: The data from this study support the use of acute stroke therapy for patients with advanced age as the outcomes in this subgroup have improved the most over the past decade with technological advancement.

Learning Objectives: To understand the temporal trend of endovascular stroke therapy, and outcome improvement over the past decade, especially in age-specific subgroups.

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