Acute Ischemic Stroke Treatment in Germany (2015–2023): Nationwide Trends in Thrombolysis and Thrombectomy by Age and Sex
Sandra Hirsch, Karel Kostev, Christian Tanislav, Ali Hammed
Abstract
BACKGROUND: The implementation of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in acute ischemic stroke (AIS) has proven effective, offering significant benefits for patient outcomes. We therefore investigated trends in the implementation of IVT and MT in Germany between 2015 and 2023. METHODS: We conducted a retrospective analysis using German Diagnosis-Related Group (DRG) statistics from 2015 to 2023. Treatment numbers were analyzed annually based on OPS codes. We examined the age and sex distribution of patients undergoing these treatments. Additionally, we analyzed all hospital cases coded with ICD-10 for acute ischemic stroke (AIS). RESULTS: Between 2015 and 2023, the number of AIS cases in Germany slightly declined from 250,802 to 248,107 (-1.1%), with the largest annual decrease (-4.3%) occurring during the COVID-19 pandemic (2019-2020). Despite this, the use of IVT increased from 40,766 cases (16.25%) in 2015 to 48,378 (19.50%) in 2023. MT usage rose even more sharply, from 7840 cases (3.13%) to 22,445 (9.05%). Among MT recipients, the proportion of patients aged ≥80 years rose significantly, from 27.2% to 42.1%. In this age group, women consistently comprised the majority of MT patients-65.4% in 2015 and 65.5% in 2023. CONCLUSIONS: Despite a stable stroke incidence, the use of IVT-and particularly MT-continued to increase in Germany from 2015 to 2023, even during the COVID-19 pandemic. MT usage nearly tripled, especially among patients aged ≥80 years. These trends highlight a resilient stroke care system and underscore the need for future planning to meet the rising demand for endovascular treatment in an aging population.