TY - JOUR
T1 - Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry
T2 - Higher Volumes Translate in Better Outcomes
AU - Nogueira, Raul G.
AU - Haussen, Diogo C.
AU - Castonguay, Alicia
AU - Rebello, Leticia C.
AU - Abraham, Michael
AU - Puri, Ajit
AU - Alshekhlee, Amer
AU - Majjhoo, Aniel
AU - Farid, Hamed
AU - Finch, Ira
AU - English, Joey
AU - Mokin, Maxim
AU - Froehler, Michael T.
AU - Kabbani, Mo
AU - Taqi, Muhammad A.
AU - Vora, Nirav
AU - Khoury, Ramy El
AU - Edgell, Randall C.
AU - Novakovic, Roberta
AU - Nguyen, Thanh
AU - Janardhan, Vallabh
AU - Veznedaroglu, Enrol
AU - Prabhakaran, Shyam
AU - Budzik, Ron
AU - Frankel, Michael R.
AU - Nordhaus, Brittany L.
AU - Zaidat, Osama O.
N1 - Publisher Copyright:
© 2019 American Heart Association, Inc.
PY - 2019/9/1
Y1 - 2019/9/1
N2 - 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.
AB - 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.
KW - Brain ischemia
KW - Groin
KW - Humans
KW - Stents
KW - Thrombectomy
UR - http://www.scopus.com/inward/record.url?scp=85071713495&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85071713495&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.118.024639
DO - 10.1161/STROKEAHA.118.024639
M3 - Article
C2 - 31318624
AN - SCOPUS:85071713495
SN - 0039-2499
VL - 50
SP - 2455
EP - 2460
JO - Stroke
JF - Stroke
IS - 9
ER -