Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry

Abstract

Background and Purpose— It remains unclear how experience influences outcomes after the advent of stent retriever technology. We studied the relationship between site experience and outcomes in the Trevo Acute Ischemic Stroke multicenter registry. Methods— The 24 sites that enrolled patients in the Trevo Acute Ischemic Stroke registry were trichotomized into low-volume (<2 cases/month), medium-volume (2–4 cases/month), and high-volume centers (>4 cases/month). Baseline features, imaging, and clinical outcomes were compared across the 3 volume strata. A multivariable analysis was performed to assess whether outcomes were influenced by site volumes. Results— A total of 624 patients were included and distributed as low- (n=188 patients, 30.1%), medium- (n=175, 28.1%), and high-volume (n=261, 41.8%) centers. There were no significant differences in terms of age (mean, 66±16 versus 67±14 versus 65±15; P =0.2), baseline National Institutes of Health Stroke Scale (mean, 17.6±6.5 versus 16.8±6.5 versus 17.6±6.9; P =0.43), or occlusion site across the 3 groups. Median (interquartile range) times from stroke onset to groin puncture were 266 (181.8–442.5), 239 (175–389), and 336.5 (221.3–466.5) minutes in low-, medium-, and high-volume centers, respectively ( P =0.004). Higher efficiency and better outcomes were seen in higher volume sites as demonstrated by shorter procedural times (median, 97 versus 67 versus 69 minutes; P <0.001), higher balloon guide catheter use (40% versus 36% versus 59%; P ≤0.0001), and higher rates of good outcome (90-day modified Rankin Scale [mRS], ≤2; 39% versus 50% versus 53.4%; P =0.02). There were no appreciable differences in symptomatic intracranial hemorrhage or 90-day mortality. After adjustments in the multivariable analysis, there were significantly higher chances of achieving a good outcome in high- versus low-volume (odds ratio, 1.67; 95% CI, 1.03–2.7; P =0.04) and medium- versus low-volume (odds ratio, 1.75; 95% CI, 1.1–2.9; P =0.03) centers, but there were no significant differences between high- and medium-volume centers ( P =0.86). Conclusions— Stroke center volumes significantly influence efficiency and outcomes in mechanical thrombectomy.

Is mRankin scale correlated with mTICI? A systematic review and meta-regression on RCTs and registries

“…Firstly, RCTs and registries design (structured vs real world). Secondly, RCTs’ centres may be more expert in mechanical thrombectomy than registries’ one with a higher number of procedures per year which is a known prognostic factor[32]. Thirdly, the post-stroke care could be more effective in a high-volume centre.…”

Performance evolution over 645 acute stroke thrombectomies in a public Brazilian healthcare institution

“…Three previous large studies in the ''poststent retriever'' era assessed thrombectomy case volume and outcomes. [4][5][6] In a study assessing a large multicenter database in the US, Rinaldo et al 4 observed significantly higher mortality in low-volume centers (<27 cases), than in medium-(!27-<132 cases), or highvolume (!132 cases) centers. However, the mortality rates between the medium (14.9%) and high-volume (9.8%) centers did not significantly differ.…”

Balloon guide catheters: use, reject, or randomize?

“…Nevertheless, many interventionists report that they do not routinely use BGCs. Recent studies showed that only 1 out of 4 neurointerventionalists routinely use a BGC when performing EVT [12] and that BGC use is particularly uncommon in low-volume centers [13]. What are the most common reasons for this reluctance, despite the considerably encouraging evidence available so far?…”