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Between-center variation in outcome after endovascular treatment of acute stroke: Analysis of two nationwide registries

Circulation: Cardiovascular Quality and Outcomes Feb 03, 2022

Considering the relevance of understanding the differences in patient outcomes between endovascular thrombectomy (EVT) centers for improving stroke care, researchers herein investigated between-center variation in functional outcome of patients with acute ischemic stroke who were treated with EVT. Further, they assessed the extent to which modifiable center characteristics may explain this variation.

  • Data of patients with stroke treated with EVT were retrieved using the nationwide registry in the Netherlands and in the Czech Republic.

  • A total of 4,518 patients treated in 33 centers were included.

  • Researchers expressed between-center variation as the relative difference in odds of a more favorable modified Rankin Scale score between a relatively better performing center (75th percentile) and a relatively worse performing center (25th percentile).

  • Following adjustment for patient characteristics, there appeared 1.46 times higher odds of a more favorable outcome in a center at the 75th percentile of the outcome distribution compared with the odds in a center at the 25th percentile.

  • Center-specific characteristics, such as time to reperfusion, could largely explain the considerable between-center variation in patient outcomes after EVT for acute ischemic stroke.

  • A decrease in center-specific differences, and an overall improvement in outcome of patients with acute ischemic stroke may occur in correlation with an improvement in the parameters.

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