Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

In this case more treatment volume doesn't translate to better outcomes because treatment time is miniscule for dead neurons compared to all the billions of neurons dying by not stopping the 5 causes of the neuronal cascade of death in the first week.

Or maybe they aren't doing enough cases:

To Master Stroke Thrombectomy, It Takes Way More Than 50 Cases

The latest here:

Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

Laura C.C. van Meenen, Sanne J. den Hartog, Adrien E. Groot, Bart J. Emmer, Martin D. Smeekes, Arjen Siegers, Geert Jan Kommer, Charles B.L.M. Majoie, Yvo B.W.E.M. Roos, … See all authors

First published: 15 September 2021

https://doi.org/10.1111/ene.15107

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi:10.1111/ene.15107

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Abstract

Background

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 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 modelling. 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 post-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 (IQR: 12-19) and median time from stroke onset to arrival at the PSC was 53 minutes (IQR: 38-90). 83% had received intravenous thrombolysis. EVT referral volume was not associated with PSC-door-to-groin time (adjusted coefficient: -0.49 minutes/annual referral, 95% CI: -1.27 to 0.29), CSC-door-to-groin time (adjusted coefficient: -0.34 minutes/annual referral, 95% CI: -0.69 to 0.01) or 90-day mRS score (adjusted cOR: 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.