title: Higher volume endovascular stroke centers have faster times to treatment, higher reperfusion rates and higher rates of good clinical outcomes.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurology, Emory University School of Medicine, Marcus Stroke and Neuroscience Center, Grady Memorial Hospital, Atlanta, GA, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Gupta
authors.forename: Anat
authors.initials: A
authors.lastname: Horev
authors.forename: Thanh
authors.initials: T
authors.lastname: Nguyen
authors.forename: Dheeraj
authors.initials: D
authors.lastname: Gandhi
authors.forename: Dolora
authors.initials: D
authors.lastname: Wisco
authors.forename: Brenda A
authors.initials: BA
authors.lastname: Glenn
authors.forename: Ashis H
authors.initials: AH
authors.lastname: Tayal
authors.forename: Bryan
authors.initials: B
authors.lastname: Ludwig
authors.forename: John B
authors.initials: JB
authors.lastname: Terry
authors.forename: Raphael Y
authors.initials: RY
authors.lastname: Gershon
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
authors.forename: Paul F
authors.initials: PF
authors.lastname: Clemmons
authors.forename: Michael R
authors.initials: MR
authors.lastname: Frankel
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Cronin
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Anderson
authors.forename: Muhammad Shazam
authors.initials: MS
authors.lastname: Hussain
authors.forename: Kevin N
authors.initials: KN
authors.lastname: Sheth
authors.forename: Samir R
authors.initials: SR
authors.lastname: Belagaje
authors.forename: Melissa
authors.initials: M
authors.lastname: Tian
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057510:Endovascular Procedures / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015424:Reperfusion / Q000379:methods / Q000592:standards*; D012189:Retrospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D062606:Tertiary Care Centers / Q000592:standards*; D013997:Time Factors; D016896:Treatment Outcome