Nationwide Variation in Thrombectomy Utilization for Large Vessel Occlusion Stroke in Medicare Beneficiaries in the U.S.
Sabah Islam1, Harshita Sarambale1, Sherli Koshy-Chenthittayil2
1College of Osteopathic Medicine, 2Office of Institutional Effectiveness, Touro University Nevada
Objective:
To visualize and analyze geographic disparities in mechanical thrombectomy utilization among Medicare beneficiaries in the United States.
Background:
Mechanical Thrombectomy (MT) is performed for acute ischemic stroke due to large vessel occlusion (LVO). Its use has increased nationally, but access remains uneven, particularly when comparing urban and rural regions. Understanding geographic variation in utilization can help visualize accessibility in care and inform future healthcare delivery strategies.
Design/Methods:
The 2023 CMS Physician & Other Practitioners (Provider & Service) dataset was used to conduct a cross-sectional analysis in R studio. HCPCS code 61645 was used to isolate MT procedures. Counts of services, unique beneficiaries, and providers by state were stratified. Procedure rates per 100,000 beneficiaries were calculated by normalizing against December 2023 Medicare enrollment data. Rural-urban distribution was determined using RUCA classifications, and facility setting (facility vs non-facility) was assessed.
Results:
In 2023, a total of 7,323 thrombectomy procedures were performed for 7,249 unique beneficiaries across 438 providers. Nearly all procedures (99.7%) occurred in facility settings, and 7,301 procedures were performed in urban areas versus 22 in rural or unknown settings. There was marked state-level variation: Alaska demonstrated the highest rate of 844.6 procedures per 100,000 beneficiaries (15 cases), while Oregon had the lowest at 2.4. The disparity ratio between the highest and lowest states was approximately 351-fold. States with high MT utilization included Delaware (99.1) and Maryland (83.4), while several states including Utah and West Virginia had rates below 10 per 100,000 beneficiaries.
Conclusions:
Mechanical thrombectomy use is concentrated in urban areas with state-to-state variation, highlighting geographic disparities in access to stroke management. These results are preliminary. Future steps include performing statistical analyses for associations in the current dataset and incorporating multi-year CMS data and additional state-level predictors to better characterize variability in access to care.
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