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Meenen, L.C.C. van; Hartog, S.J. den; Groot, A.E.; Emmer, B.J.; Smeekes, M.D.; Siegers, A.; ... ; MR CLEAN Registry Investigators (2021)

Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

Article / Letter to editor
Background and purpose We investigated whether the annual volume of patients with acute ischemic stroke referred from a primary stroke center (PSC) for endovascular treatment (EVT) is associated with treatment times and functional outcome. Methods We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) registry (2014-2017). We included patients with acute ischemic stroke of the anterior circulation who were transferred from a PSC to a comprehensive stroke center (CSC) for EVT. We examined the association between EVT referral volume of PSCs and treatment times and functional outcome using multivariable regression modeling. The main outcomes were time from arrival at the PSC to groin puncture (PSC-door-to-groin time), adjusted for estimated ambulance travel times, time from arrival at the CSC to groin puncture (CSC-door-to-groin time), and modified Rankin Scale (mRS) score at 90 days after stroke....Show moreBackground and purpose We investigated whether the annual volume of patients with acute ischemic stroke referred from a primary stroke center (PSC) for endovascular treatment (EVT) is associated with treatment times and functional outcome. Methods We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) registry (2014-2017). We included patients with acute ischemic stroke of the anterior circulation who were transferred from a PSC to a comprehensive stroke center (CSC) for EVT. We examined the association between EVT referral volume of PSCs and treatment times and functional outcome using multivariable regression modeling. The main outcomes were time from arrival at the PSC to groin puncture (PSC-door-to-groin time), adjusted for estimated ambulance travel times, time from arrival at the CSC to groin puncture (CSC-door-to-groin time), and modified Rankin Scale (mRS) score at 90 days after stroke. Results Of the 3637 patients in the registry, 1541 patients (42%) from 65 PSCs were included. Mean age was 71 years (SD +/- 13.3), median National Institutes of Health Stroke Scale score was 16 (interquartile range [IQR]: 12-19), and median time from stroke onset to arrival at the PSC was 53 min (IQR: 38-90). Eighty-three percent had received intravenous thrombolysis. EVT referral volume was not associated with PSC-door-to-groin time (adjusted coefficient: -0.49 min/annual referral, 95% confidence interval [CI]: -1.27 to 0.29), CSC-door-to-groin time (adjusted coefficient: -0.34 min/annual referral, 95% CI: -0.69 to 0.01) or 90-day mRS score (adjusted common odds ratio: 0.99, 95% CI: 0.96-1.01). Conclusions In patients transferred from a PSC for EVT, higher PSC volumes do not seem to translate into better workflow metrics or patient outcome.Show less
high-volume hospitals
low-volume hospitals
ischemic stroke
thrombectomy
workflow
All authors
Meenen, L.C.C. van; Hartog, S.J. den; Groot, A.E.; Emmer, B.J.; Smeekes, M.D.; Siegers, A.; Kommer, G.J.; Majoie, C.B.L.M.; Roos, Y.B.W.E.M.; Es, A.C.G.M. van; Dippel, D.W.; Worp, H.B. van der; Lingsma, H.F.; Roozenbeek, B.; Coutinho, J.M.; MR CLEAN Registry Investigators
Date
2021-09-23
Journal
European Journal of Neurology
Volume
28
Issue
12
Pages
4031 - 4038
DOI
doi:10.1111/ene.15107
Link
https://onlinelibrary.wiley.com/doi/10.1111/ene.15107