Journal
EUROPEAN STROKE JOURNAL
Volume 8, Issue 1, Pages 224-230Publisher
SAGE PUBLICATIONS LTD
DOI: 10.1177/23969873221145771
Keywords
Acute ischemic stroke; endovascular treatment; center type
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This study compared the outcomes of endovascular treatment (EVT) for acute ischemic stroke (AIS) between level 1 and level 2 intervention centers, and assessed whether differences in outcomes could be explained by center volume (CV). The results showed that there were no significant differences in the modified Rankin scale (mRS), NIHSS score, procedure time, and door-to-groin time between the two center types, except for the recanalization rate.
Background: Endovascular treatment (EVT) for acute ischemic stroke (AIS) is performed in intervention centers that provide the full range of neuro(endo)vascular care (level 1) and centers that only perform EVT for AIS (level 2). We compared outcomes between these center types and assessed whether differences in outcomes could be explained by center volume (CV). Patients and methods: We analyzed patients included in the MR CLEAN Registry (2014-2018), a registry of all EVT-treated patients in the Netherlands. Our primary outcome was the shift on the modified Rankin scale (mRS) after 90 days (ordinal regression). Secondary outcomes were the NIHSS 24-48 h post-EVT, door-to-groin time (DTGT), procedure time (linear regression), and recanalization (binary logistic regression). We compared outcomes between level 1 and 2 centers using multilevel regression models, with center as random intercept. We adjusted for relevant baseline factors, and in case of observed differences, we additionally adjusted for CV. Results: Of the 5144 patients 62% were treated in level 1 centers. We observed no significant differences between center types in mRS (adjusted(a)cOR: 0.79, 95% CI: 0.40 to 1.54), NIHSS (a beta: 0.31, 95% CI: -0.52 to 1.14), procedure duration (a beta: 0.88, 95% CI: -5.21 to 6.97), or DTGT (a beta: 4.24, 95% CI: -7.09 to 15.57). The probability for recanalization was higher in level 1 centers compared to level 2 centers (aOR 1.60, 95% CI: 1.10 to 2.33), and this difference probably depended on CV. Conclusions: We found no significant differences, that were independent of CV, in the outcomes of EVT for AIS between level 1 and level 2 intervention centers.
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