TY - JOUR
T1 - Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke
AU - van Meenen, Laura C. C.
AU - den Hartog, Sanne J.
AU - Groot, Adrien E.
AU - Emmer, Bart J.
AU - Smeekes, Martin D.
AU - Siegers, Arjen
AU - Kommer, Geert Jan
AU - Majoie, Charles B. L. M.
AU - Roos, Yvo B. W. E. M.
AU - van Es, Adriaan C. G. M.
AU - Dippel, Diederik W.
AU - the MR CLEAN Registry Investigators
AU - van der Worp, H. Bart
AU - Lingsma, Hester F.
AU - Roozenbeek, Bob
AU - Coutinho, Jonathan M.
N1 - Funding Information: B.J.E. reports funding from ZonMW (Leading the Change) and Health Holland paid to the institution, and has received grants paid to the institution from Stryker Neurovascular in the past and personal fees from Dekra and Novartis outside the submitted work. C.B.L.M.M. reports grants from CVON/Dutch Heart Foundation, European Commission, TWIN Foundation, Stryker, and Health Evaluation Netherlands, all outside the submitted work (paid to the institution), and is a shareholder of Nico.lab, a company that focuses on the use of artificial intelligence for medical image analysis. Y.B.W.E.M.R. is a minor shareholder of Nico.lab. H.B.v.d.W. has received speaker's fees from Boehringer Ingelheim, has served as a consultant to Boehringer Ingelheim, and is the recipient of unrestricted grants from the Dutch Heart Foundation and the European Union for the conduct of trials on acute treatment for stroke, all outside the submitted work. D.W.D. reports fees for consultations by Stryker and Bracco Imaging; grants from the Dutch Heart Foundation, Brain Foundation Netherlands, Netherlands Organisation for Health Research and Development, and Health Holland Top Sector Life Sciences & Health; and unrestricted grants from AngioCare BV, Covidien/EV3, MEDAC Gmbh/LAMEPRO, Top Medical/Concentric, Stryker, Stryker European Operations BV, Penumbra Inc., Medtronic, Thrombolytic Science, LLC, and Cerenovus, all paid to the institution. J.M.C. received unrelated research support from the Dutch Heart Foundation, Bayer, Boehringer, and Medtronic. All fees were paid to his employer. The other authors report no conflicts. Funding Information: The MR CLEAN Registry was funded and performed by Erasmus MC University Medical Center, Amsterdam UMC, and Maastricht University Medical Center. The MR CLEAN Registry was additionally funded by the TWIN Foundation, which played no role in the study design and patient enrollment nor in data collection, analysis, or writing of the article Publisher Copyright: © 2021 The Authors. European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.
PY - 2021/12
Y1 - 2021/12
N2 - 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. 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.
AB - 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. 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.
KW - high-volume hospitals
KW - ischemic stroke
KW - low-volume hospitals
KW - thrombectomy
KW - workflow
UR - http://www.scopus.com/inward/record.url?scp=85115726547&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/ene.15107
DO - https://doi.org/10.1111/ene.15107
M3 - Article
C2 - 34528335
SN - 1351-5101
VL - 28
SP - 4031
EP - 4038
JO - European journal of neurology
JF - European journal of neurology
IS - 12
ER -