Case Volume and Outcomes in Endovascular Thrombectomy

Study Questions:

What is the effect of endovascular thrombectomy (EVT) cumulative case volume (EVT-CCV) on outcomes of acute stroke patients?

Methods:

The investigators identified all patients who underwent EVT for anterior circulation large vessel occlusion. Patients who met enrollment criteria were grouped into five based on the number of previous cases at each hospital. The number of cases that were recruited from each hospital and then assigned to each group (n) was designed to increase by the function of 10×2(n-1); group 1 consisted of cases 1-10 at each hospital, group 2 was cases 11-30, group 3 was cases 31-70, group 4 was cases 71-150, and group 5 was cases ≥151. The authors tested whether the EVT-CCV group was associated with procedural and clinical outcomes. Multivariate binary logistic regression analysis was performed to test whether the EVT-CCV group was independently associated with recanalization and good outcome.

Results:

Nine hundred fifty-five patients fulfilled the enrollment criteria. Recanalization and good outcome positively correlated with the EVT-CCV group (p < 0.001 [correlation coefficient, r = 0.122] for recanalization; p = 0.002 [r = 0.099] for good outcome), whereas symptomatic intracranial hemorrhage (ICH) and mortality negatively correlated (p = 0.039 [r = - 0.067] for symptomatic ICH; p = 0.016 [r = - 0.078] for mortality). The EVT-CCV group was independently associated with recanalization (odds ratio [OR], 1.182; 95% confidence interval [CI], 1.029-1.358) and good outcome (OR, 1.187; 95% CI, 1.053-1.337).

Conclusions:

The authors concluded that with increased EVT-CCV, recanalization and good outcome increased, whereas symptomatic ICH and mortality decreased.

Perspective:

This study reports that increased EVT-CCV positively correlated with recanalization and good outcome rates, and negatively correlated with symptomatic ICH, mortality, and door-to-puncture, and puncture-to-recanalization times. Furthermore, the EVT-CCV group was independently associated with both recanalization success and good outcome. These results could provide reference data for planning future regional systems of care for acute stroke, an important issue in the era of contemporary endovascular thrombectomy.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Aortic Surgery, Cardiac Surgery and Arrhythmias

Keywords: Coronary Occlusion, Endovascular Procedures, Intracranial Hemorrhages, Outcome and Process Assessment (Health Care), Quality of Health Care, Secondary Prevention, Stroke, Thrombectomy, Vascular Diseases


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