The following are key points to remember from this article on real-world treatment trends in endovascular stroke therapy (EST):

1. This study addresses the population-level patterns in EST performance in US hospitals and compares EST outcomes from higher- versus lower-volume centers.
2. In this large population-level study of patients treated with EST from 2006 to 2016, there was a linear increase in annual treatment rates over time, with a large jump in 2015, corresponding to the release of multiple positive randomized clinical trials.
3. This increase in procedural volume was associated with an increase in the number of centers performing EST, with a resulting shift in distribution of procedures across a substantially greater number of hospitals.
4. Overall, procedural outcomes improved over time, which may have been related to improvements in EST devices and techniques.
5. This study reports a continuous improvement in the rate of good outcomes with increasing annual EST hospital volume. There was a positive association between EST volume and favorable discharge outcomes in EST-performing hospitals.
6. Improvements in patient selection, technical performance of EST, and postprocedural care with neurocritical care and neuroscience nurses may justify concentrating EST care at specialized centers for some stroke systems of care, and also demonstrates that prior studies examining older cohorts may not be relevant in current practice paradigms.
7. While improved EST outcomes at higher-volume centers are logical and consistent with prior studies, these findings should not be extrapolated to imply that all stroke systems of care should focus on concentrating EST treatments at only a few high-volume centers rather than disseminating EST treatments more widely.
8. In some regions, distance, cost, and time make such transfers impractical. Determining which system of care works best may ultimately depend in a large part on local geographies and medical resource availability.
9. An evaluation of existing trends using population-based aggregate data is critically important for designing future networks and policies for stroke care to develop optimal infrastructures to accommodate the demand created by novel endovascular therapeutics.
10. Additional studies are indicated to assess whether patients who were treated at lower-volume centers would have done better or worse had they been transferred to a high-volume EST hospital with some inevitable delay in treatment.

Keywords: Endovascular Procedures, Hospitals, High-Volume, Outcome Assessment, Health Care, Secondary Prevention, Stroke, Treatment Outcome, Thrombectomy, Vascular Diseases

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