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Background: Stroke Unit Care (SUC), intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) are evidence-based treatment options for acute ischemic stroke (AIS). Using nationwide comprehensive administrative data from Germany, we recently reported nationwide development of AIS admissions, SUC rates, IVT rates and MT rates in Germany between 2010 and 2016. In this update paper, we analyze data on the further development of these data to 2019 after publication of time window extensions for recanalization therapies., Methods: We considered all hospitalized cases with the main diagnosis of the ICD-10-GM code I63 (AIS) for the year 2019. We identified stroke therapies by using the corresponding Operating and Procedure Keys for IVT, MT and SUC out of the DRG statistics. Regional analyses are based on data from the 412 German administrative districts and cities. We compared the results with those from 2016., Results: Number of hospitalized AIS patients showed a mild decrease in 2019 (n = 225,531) compared with 2016 (n = 227,687), with significant more AIS patients treated on a stroke unit in 2019 (n = 167,799; 74.4% vs. n = 164,270; 72.1%, p < 0.001). The rate of IVT further increased from 14.9% (n = 33,916) in 2016 to 16.3% (n = 36,745) in 2019 (p < 0.001). Similarly, the MT rate increased from 4.3% (n = 9795) in 2016 to 7.2% (n = 16,135) in 2019 (p < 0.001). There was still a high regional variability for MT (1.4 to 15.2%) according to the place of residence of the AIS patients., Conclusions: In Germany, the rates of recanalization therapies in patients with AIS continued to increase from 2016 to 2019. Compared to IVT-rates and numbers, the respective data for MT procedures showed an even more pronounced increase.

Background: Comparing health care parameters of acute ischemic stroke (AIS) patients with and without concurrent coronavirus disease 2019 (Covid-19, SARS-CoV-2 infection), may be helpful in terms of optimizing clinical and public health care during pandemic., Methods: We evaluated a nationwide administrative database of all hospitalized patients with main diagnosis of acute ischemic stroke with/without diagnosis of Covid-19 who were hospitalized during the time period from January 16th to May 15th, 2020. Data from a total of 1463 hospitals in Germany were included. We compared case numbers, treatment characteristics (intravenous thrombolysis, IVT; mechanical thrombectomy, MT; treated on an intensive care unit, stroke unit or regular ward) and in-hospital mortality of AIS with and without concurrent diagnosis of Covid-19., Results: From a total of 30,864 hospitalized Covid-19 patients during the evaluation period in Germany, we identified a subgroup of 213 patients with primary diagnosis of AIS. Compared to the 68,700 AIS patients without Covid-19, this subgroup showed a similar rate of IVT (16.4% vs. 16.5%, p  = 0.985) but a significantly lower rate of MT (3.8% vs. 7.9%, p  = 0.017). In-hospital mortality rate was significantly higher in patients with AIS and concurrent Covid-19 compared to non-infected AIS patients (22.5% vs. 7.8%, p  < 0.001)., Conclusion: These nationwide data point out differences in mortality and medical treatment regime between AIS patients with and without concurrent Covid-19. Since the pandemic is still ongoing, these data draw attention to AIS as a less frequent but often fatal comorbidity in Covid-19 patients., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: Comprehensive administrative data on TIA and stroke cases and treatment modalities are fundamental for improving structural conditions and adjusting future strategies of stroke care., Methods: The nationwide administrative database (German federal statistical office) was used to extract all adult inpatient TIA and stroke cases and corresponding procedural codes for the period 2011-2017. Numbers were specified according to age, sex, stroke unit (SU) and critical care treatment (ICU), early transfer, and in-hospital mortality., Findings: Inpatient adult TIA/stroke cases increased from annually 102,406 / 250,199 (2011) to 106,245 / 264,208 (2017). 84% of strokes were ischemic (AIS) also having the highest relative increase most likely due to more accurate coding within the time period, 68.2% of AIS were treated on SUs. 78% of hemorrhagic strokes were intracerebral hematomas (ICH; rather than subarachnoid hemorrhages [SAH]). Hemorrhagic strokes were increasingly treated on SUs (32.6% [2011], 37.8% [2017]). 68.8% of SAH were treated on ICUs (ICH:36.3%, AIS:10.3%). Early transfer in AIS increased (2.0 to 3.1%). Hemorrhagic strokes were associated with higher in-hospital mortality (SAH:19.6%, ICH:28.2%, AIS:7.3%)., Interpretation: The absolute increase of strokes presumably reflects the aging society and more awareness for cerebrovascular disease. The relative increase of AIS may be attributable to an increased neurological expertise. The increasing amount of early transfers in AIS reflects new specialized treatment options. Our findings reflect the need for structural adjustments in inpatient stroke care., Competing Interests: Competing interestsJE has received travel grants from Daiichi-Sankyo and Bayer Vital and grants for the realization of scientific meetings by Bayer Health Care, Boehringer Ingelheim, Sanofi Aventis, and Pfizer. DB has received orders for analysis of the G-DRG system from Boehringer Ingelheim. RW has received speaker honoria from Medtronic/Covidien and Bristol Myers Squibb, and from serving on a scientific advisory board of Medtronic. AHK reports no disclosures. CW has received speaker and consultancy honoraria from Alexion, Amgen, Bayer-Schering. WH has received speaker and consultancy honoraria from Boehringer Ingelheim, Medtronic, Cerenovus and a research grant to perform ECASS4 from Boehringer Ingelheim. CK has received speaker honoraria and/or travel grants for scientific meetings from Bayer Vital, Boehringer-Ingelheim, and Daichii-Sankyo., (© The Author(s) 2019.)

Background: Mechanical thrombectomy (MT) is a new evidence-based treatment option for large vessel occlusion in the anterior brain circulation. Using comprehensive administrative data from Germany, we analysed the nationwide development of intravenous thrombolysis (IVT) and MT in Germany between 2010 and 2016., Methods: We considered all documented cases ( n  = 1,515,634) with a main diagnosis of the ICD-10-GM code I63 (ischemic stroke) and identified specific stroke recanalization therapy by using the corresponding Operating and Procedure Key for systemic thrombolysis and mechanical thrombectomy out of the DRG statistics. Regional analyses are based on data from the 413 German administrative districts and cities and the obligatory quality reports of all hospitals. We distinguished between rates of MT related to place of residence of patients and place of treatment., Results: Coded ischemic strokes increased by 10.2% from 2010 ( n  = 206.688) to 2016 ( n  = 227.687). The rate of IVT increased from 8.9% in 2010 to 14.9% in 2016 and the rate of MT increased from 0.8% in 2010 to 4.7% in 2016 with a strong increase in 2015 and 2016. There was a high regional variability of MT according to place of residence of patients between 0 and 11.2% in 2016 with significant lower treatment rates in rural compared to urban areas (3.8 vs 5.4%). Mean age of patients treated with MT increased from 67.8 years in 2010 to 73.3 years in 2016 and almost reached the mean age of IVT treated patients (74.4 years). The number of hospitals coding MT increased from 91 to 193 from 2010 to 2016, but 80% of all MT procedures were performed in neurointerventional centers with ≥50 procedures/year in 2016., Conclusions: The rate of IVT in patients with acute ischemic stroke in Germany continues to rise and has reached 14.9% nationwide. The increase of MT is even more pronounced and was triggered by the evidence after publication of the MT randomized trials. There is still a high regional variability with significant lower MT rates in rural areas., Competing Interests: Competing interestsRalph Weber received speaker honoria from Medtronic/Covidien and Bristol Myers Squibb, and from serving on a scientific advisory board of Medtronic. He received travel grants from Boehringer Ingelheim and Bayer Vital. Jens Eyding received travel grants from Boehringer Ingelheim and Bayer Vital and grants for the realization of scientific meetings by Bayer Health Care, Boehringer Ingelheim, Sanofi Aventis, Pfizer. Martin Kitzrow received speaker honoria from Medtronic/Covidien, Bristol Myers Squibb, Boehringer Ingelheim, Pfizer and Daiichi Sankyo. He received travel grants from Boehringer Ingelheim, Bayer Vital and Pfizer. Dirk Bartig received orders for analysis of the G-DRG system from Boehringer Ingelheim. Christian Weimar received speaker honoria from AMGEN, Bayer-Schering, Biogen Idec, Boehringer Ingelheim, Bristol-Myers Squib, Daiichi Sankyo, Penumbra as well as research grants from Johnson&Johnson and Boehringer Ingelheim. Werner Hacke received speaker and consultancy honoraria from Boehringer Ingelheim, Medtronic, Cerenovus and a research grant to perform ECASS4 from Boehringer Ingelheim and is the Editor-in-Chief of Neurological Research and Practice. Christos Krogias received speaker honoraria and/or travel grants for scientific meetings from Bayer Vital, Boehringer-Ingelheim and Daichii-Sankyo., (© The Author(s) 2019.)