The establishment of mechanical thrombectomy (MT) as a first-line treatment for select patients with acute ischemic stroke (AIS) and the expansion of stroke systems of care have been major advancements in the care of patients with AIS. In this study, the authors aimed to identify temporal trends in the usage of tissue-type plasminogen activator (tPA) and MT within the AIS population from 2012 to 2018, and the relationship to mortality.

Using a nationwide private health insurance database, 117,834 patients who presented with a primary AIS between 2012 and 2018 in the United States were identified. The authors evaluated temporal trends in tPA and MT usage and clinical outcomes stratified by treatment and age using descriptive statistics.

Among patients presenting with AIS in this population, the mean age was 69.1 years (SD ± 12.3 years), and 51.7% were female. Between 2012 and 2018, the use of tPA and MT increased significantly (tPA, 6.3% to 11.8%, p < 0.0001; MT, 1.6% to 5.7%, p < 0.0001). Mortality at 90 days decreased significantly in the overall AIS population (8.7% to 6.7%, p < 0.0001). The largest reduction in 90-day mortality was seen in patients treated with MT (21.4% to 14.1%, p = 0.0414) versus tPA (11.8% to 7.0%, p < 0.0001) versus no treatment (8.3% to 6.3%, p < 0.0001). Age-standardized mortality at 90 days decreased significantly only in patients aged 71–80 years (11.4% to 7.8%, p < 0.0001) and > 81 years (17.8% to 11.6%, p < 0.0001). Mortality at 90 days stagnated in patients aged 18 to 50 years (3.0% to 2.2%, p = 0.4919), 51 to 60 years (3.8% to 3.9%, p = 0.7632), and 61 to 70 years (5.5% to 5.2%, p = 0.2448).

From 2012 to 2018, use of tPA and MT increased significantly, irrespective of age, while mortality decreased in the entire AIS population. The most dramatic decrease in mortality was seen in the MT-treated population. Age-standardized mortality improved only in patients older than 70 years, with no change in younger patients.

机械取栓 (MT) 作为急性缺血性卒中 (AIS) 特定患者的一线治疗方法的建立和卒中护理系统的扩展，已成为 AIS 患者护理的重大进步。在这项研究中，作者旨在确定 2012 年至 2018 年 AIS 人群中组织型纤溶酶原激活剂 (tPA) 和 MT 使用的时间趋势，以及与死亡率的关系。

使用全国性的私人健康保险数据库，确定了 2012 年至 2018 年在美国出现原发性 AIS 的 117,834 名患者。作者使用描述性统计评估了 tPA 和 MT 使用的时间趋势以及按治疗和年龄分层的临床结果。

在该人群中出现 AIS 的患者中，平均年龄为 69.1 岁（SD ± 12.3 岁），51.7% 为女性。2012 年至 2018 年间，tPA 和 MT 的使用显着增加（tPA，6.3% 至 11.8%，p < 0.0001；MT，1.6% 至 5.7%，p < 0.0001）。整个 AIS 人群的 90 天死亡率显着下降（8.7% 至 6.7%，p < 0.0001）。在接受 MT 治疗的患者（21.4% 至 14.1%，p = 0.0414）与 tPA（11.8% 至 7.0%，p < 0.0001）与未治疗（8.3% 至 6.3%，p）相比，90 天死亡率降低幅度最大< 0.0001)。仅 71-80 岁（11.4% 至 7.8%，p < 0.0001）和 > 81 岁（17.8% 至 11.6%，p < 0.0001）患者的 90 天年龄标准化死亡率显着降低。18 至 50 岁（3.0% 至 2.2%，p = 0.4919）、51 至 60 岁（3.

从 2012 年到 2018 年，tPA 和 MT 的使用显着增加，而与年龄无关，而整个 AIS 人群的死亡率下降。在 MT 治疗的人群中观察到死亡率的最显着下降。年龄标准化死亡率仅在 70 岁以上的患者中有所改善，年轻患者没有变化。