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Higher volume endovascular stroke centers have faster times to treatment, higher reperfusion rates and higher rates of good clinical outcomes
  1. Rishi Gupta1,
  2. Anat Horev2,
  3. Thanh Nguyen3,
  4. Dheeraj Gandhi4,
  5. Dolora Wisco5,
  6. Brenda A Glenn1,
  7. Ashis H Tayal6,
  8. Bryan Ludwig7,
  9. John B Terry7,
  10. Raphael Y Gershon8,
  11. Tudor Jovin2,
  12. Paul F Clemmons9,
  13. Michael R Frankel1,
  14. Carolyn A Cronin10,
  15. Aaron M Anderson1,
  16. Muhammad Shazam Hussain5,
  17. Kevin N Sheth10,
  18. Samir R Belagaje1,
  19. Melissa Tian6,
  20. Raul G Nogueira1
  1. 1Department of Neurology, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA
  2. 2Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
  3. 3Departments of Neurology and Radiology, Boston University School of Medicine, Boston, MA, USA
  4. 4Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA
  5. 5Cerebrovascular Center, The Cleveland Clinic Foundation, Cleveland, OH, USA
  6. 6Department of Neurology, Allegheny General Hospital, Pittsburgh, PA, USA
  7. 7Departments of Radiology and Neurology, Miami Valley Hospital, Wright State University Boonshoft School of Medicine, Dayton, OH, USA
  8. 8Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, USA
  9. 9Department of Radiology, Vanderbilt University School of Medicine, Nashville, TN, USA
  10. 10Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, USA
  1. Correspondence to Dr Raul G Nogueira, 49 Jesse Hill Jr Drive, SE, Faculty Office Building #396, Atlanta, GA 30303, USA; rnoguei{at}


Background and purpose Technological advances have helped to improve the efficiency of treating patients with large vessel occlusion in acute ischemic stroke. Unfortunately, the sequence of events prior to reperfusion may lead to significant treatment delays. This study sought to determine if high-volume (HV) centers were efficient at delivery of endovascular treatment approaches.

Methods A retrospective review was performed of nine centers to assess a series of time points from obtaining a CT scan to the end of the endovascular procedure. Demographic, radiographic and angiographic variables were assessed by multivariate analysis to determine if HV centers were more efficient at delivery of care.

Results A total of 442 consecutive patients of mean age 66±14 years and median NIH Stroke Scale score of 18 were studied. HV centers were more likely to treat patients after intravenous administration of tissue plasminogen activator and those transferred from outside hospitals. After adjusting for appropriate variables, HV centers had significantly lower times from CT acquisition to groin puncture (OR 0.991, 95% CI 0.989 to 0.997, p=0.001) and total procedure times (OR 0.991, 95% CI 0.986 to 0.996, p=0.001). Additionally, patients treated at HV centers were more likely to have a good clinical outcome (OR 1.86, 95% CI 1.11 to 3.10, p<0.018) and successful reperfusion (OR 1.82, 95% CI 1.16 to 2.86, p<0.008).

Conclusions Significant delays occur in treating patients with endovascular therapy in acute ischemic stroke, offering opportunities for improvements in systems of care. Ongoing prospective clinical trials can help to assess if HV centers are achieving better clinical outcomes and higher reperfusion rates.

  • Reperfusion
  • acute stroke
  • endovascular therapy
  • angiography
  • balloon
  • stent
  • intervention
  • coil
  • artery
  • standards
  • vein
  • subarachnoid
  • complication
  • aneurysm
  • eye
  • malignant
  • MRI
  • CT
  • spinal cord
  • technique
  • complication
  • catheter
  • thrombolysis
  • stroke
  • hemorrhage
  • embolic
  • coil
  • atherosclerosis
  • angioplasty

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  • Correction notice This article has been corrected since it was published Online First. The author list and the corresponding author email address have been amended.

  • Competing interests None.

  • Ethics approval Ethics approval was obtained from the IRB of each institution.

  • Provenance and peer review Not commissioned; externally peer reviewed.