Presentation (CTI)

OBJECTIVES: Mechanical thrombectomy (MT) is an established treatment for acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). Using German Diagnosis-Related Groups (G-DRG) claims data, this study examines national trends in thrombectomy utilization between 2019 and 2024, focusing on demographic and clinical differences between AIS patients treated with and without MT.
METHODS: Nationwide DRG billing data from 2019 to 2024 were analyzed to identify AIS cases due to defined arterial thrombosis (ICD-10: I63.0-5) and to distinguish in this cohort between patients treated with MT and those without. Variables included age, sex, comorbidities, hospital length of stay, in-hospital mortality and discharge disposition. Yearly trends were assessed.
RESULTS: Between 2019 and 2024, AIS hospitalizations remained stable, 227,897 in 2019 to 226,136 in 2024, while annual MT-procedures increased from 15,791 to 21,609 (+36.8%), raising the MT rate from 6.9% to 9.6%. Mean age was similar with MT (74.9y) and without MT (73.7y) and average length of hospital-stay was slightly longer for MT patients (mean 11.9 vs. 11.6 days). Female share in MT-cohort was 53.8% and 46.3% in non-MT-cohort. In 2024 MT-patients had higher NIHSS (National Institutes of Health Stroke Scale) proxies: 84.3% hemiparesis vs. 46.4% in non-MT patients, facial paresis 41.0% vs. 22.7%; dysphasia 50.6% vs. 25.5% and dysarthria 51.7% vs. 36.9%. Only in 40% of cases the Barthel-Index was coded in the first five days, mean was 28.2 in MT-patients and 49.2 in non-MT-patients. In-hospital mortality was higher in the MT group (20.7% vs. 5.7%), reflecting greater initial stroke severity. The 2024 DRG costs per stay for non-MT patients were 5,578€ (480€ per day) and 15.284€ for MT-patients (1,310€ per day).
CONCLUSIONS: DRG data from 2019-2024 reveal a steady rise in thrombectomy use in Germany amid stable stroke incidences. MT-recipient patients differ markedly from non-MT stroke patients in severity, outcomes and costs.