This study examines variation in the utilization of MT across the US by geographical region and urban-rural areas to identify disparities in implementation.

 Extensive randomized controlled trials have shown that mechanical thrombectomy (MT) is an effective treatment for acute ischemic stroke.  Systematic assessment of trends in the adoption of endovascular treatment in the United States have been limited to date.

Data from the Global Burden of Disease Collaborative Network were used to determine AIS incidence by state.  The 2016 National Inpatient Sample was accessed to identify patients who underwent MT and patients who were diagnosed with a cerebral infarct due to occlusion of middle cerebral or anterior cerebral arteries. Weighted estimates of the size of subject populations, MT patient age at admission, length of stay, and discharge status were generated and assessed across nine regional divisions and by population level.  

Approximately 13,010 mechanical thrombectomies were performed in 2016, representing 3.1% of the potentially eligible stroke population.  The proportion of patients undergoing MT varied by region and urban-rural area with greatest concentrations in large central metropolitan areas and lowest in small metro areas and rural settings when compared to the national estimate.  East North Central and West South Central regions had significantly lower proportions of MT patients.  Average patient age did not differ significantly by region or urban-rural area; however, discharge destinations did vary by both categories.

The number of MTs performed in 2016 increased approximately 1.3 times since publication of key meta-analyses in 2015.  Considering that 10% to 17% of AIS patient may be MT eligible, current rates of MT are low across all regions and urban-rural areas, particularly in the rural areas of the Midwest.  The disparities in MT utilization identified in this study will be important to monitor as the adoption of endovascular stroke treatment continues to rise.