223 - Shifting Practice Patterns in Mechanical Thrombectomy: Declining Stent-Retriever Use and Racial Differences in Utilization

Purpose: Stent-retriever thrombectomy (SRT) and aspiration thrombectomy (AT) represent the two primary strategies for mechanical thrombectomy (MT) in acute ischemic stroke (AIS). While SRT was initially the dominant technique, contemporary practice has seen increasing adoption of aspiration-based approaches. We aimed to examine national trends, outcomes, and disparities of SRT compared with AT in patients undergoing MT for AIS.

Materials and Methods: The National Inpatient Sample (NIS) was queried between 2019-2022, for admissions involving MT for AIS. Outcomes included in-hospital mortality, discharge other than home (DOTH), and 90-day poor functional outcome (per Patel et al., analogous to modified Rankin Scale >3). Negative binomial regression was used for hospital length of stay (LOS) and total charges. Trends in SRT utilization were assessed using Cochran-Armitage testing, with national estimates generated using HCUP weighting.

Results: A total of 164,355 admissions for MT were identified, of which 63,500 (38.6%) underwent SRT and 100,855 (61.4%) underwent AT. The proportion of SRT use decreased significantly between 2019 and 2022 (Trend: −2.7% per year; p< 0.001). On adjusted analysis, SRT was associated with higher odds of in-hospital mortality (OR: 1.19; p=0.002), higher odds of DOTH (OR: 1.17; p=0.004), and higher odds of poor 90-day functional outcome (OR: 1.21; p< 0.001). There was no significant difference in LOS (Coef: 0.001; p=0.941), but SRT was associated with higher hospital charges (Coef: 0.089; p< 0.001). By race, compared with White patients, Black (OR: 1.17; p=0.010) and Hispanic patients (OR: 1.37; p< 0.001) had higher odds of undergoing SRT, while patients categorized as “Other” did not differ significantly (OR: 1.18; p=0.057).

Conclusion: From 2019 to 2022, SRT utilization declined by 2.7% annually among patients undergoing MT for AIS. Compared with AT, SRT was associated with higher in-hospital mortality, higher rates of DOTH, poorer functional outcomes, and higher hospital charges, without differences in LOS. Racial differences were observed, with Black and Hispanic patients more likely to undergo SRT than White patients. These findings underscore evolving practice patterns in thrombectomy technique selection and highlight the need to understand the drivers of racial variation in procedural utilization.