O-059 Higher procedural volumes are associated with faster treatment times, better functional outcomes, and lower mortality in patients undergoing endovascular treatment for acute ischemic stroke

Abstract

<h3>Background</h3> The demonstration of the benefits of endovascular therapy (EVT) for acute ischemic stroke (AIS) originated from trials performed at carefully selected centers with high procedural volumes, experienced operators, and optimized workflows. The association of procedural volumes and outcome, and the generalizability to routine clinical practice remains uncertain. We aim to characterize the association of hospital procedural volumes with outcomes among AIS patients undergoing EVT. <h3>Methods</h3> Retrospective cohort study using data prospectively collected from January 1, 2016, to December 31, 2019, in the Get With The Guidelines-Stroke nationwide US quality registry. Participants were derived from a cohort of 60,727 AIS patients treated with EVT within 24 hours at 626 hospitals. The primary cohort excluded patients with pretreatment NIHSS≤6, onset-to-treatment time≥6 hours, and inter-hospital transfers. There were two secondary cohorts: (1) EVT metrics cohort: excluded patients with missing data on time from door-to-arterial puncture; (2) Intravenous thrombolysis (IVT) metrics cohort: only included patients receiving IVT ≤4.5 hours of onset. The primary outcome of interest was functional outcome as measured by discharge to home, functional independence at discharge, and in-hospital mortality. Secondary outcomes known to be associated with outcome were also analyzed and included symptomatic intracranial hemorrhage (sICH), successful reperfusion (mTICI2b-3), door-to-arterial puncture time, and door-to-needle time. <h3>Results</h3> The primary cohort (mean±SD age, 70.7 ±14.8 years; 51.2% female; median [IQR] baseline NIHSS18.0[13–22]; IVT use, 70.2%) comprised 21,209 patients across 595 hospitals. The EVT metrics cohort and IVT metrics cohorts comprised 47,262 and 16,889 patients across 408 and 601 hospitals, respectively. Higher procedural volumes were associated with higher odds [95% confidence interval] per 10-case-increase in volume of discharge to home (1.03[1.02–1.04],p&lt;.0001), functional independence at discharge (1.02[1.01–1.04],p=0.003), successful reperfusion (≤110 cases:1.09[1.06–1.12],p&lt;.0001; &gt;110 cases:0.99[0.95–1.03],p=0.5757), door-to-arterial-puncture times ≤90 minutes (≤70 cases:1.19[1.14–1.25],p&lt;.0001; &gt;70 cases:1.04[1.02–1.07],p=&lt;.0001), and door-to-needle times ≤60 minutes (≤110 cases:1.03[1.01–1.06],p=0.0149; &gt;110 cases:1.01[0.97–1.06],p=0.6258) and lower rates of in-hospital mortality (0.96[0.95–0.98],p&lt;.0001), sICH (≤70 cases:0.91[0.87–0.95],p&lt;.0001; &gt;70 cases:1.00[0.97–1.03],p=0.8912), and inability to ambulate at discharge (0.98[0.97–0.99],p=0.0030). All secondary measures were also associated with higher procedural volumes. <h3>Conclusions</h3> Among patients undergoing EVT for AIS in routine clinical practice, treatment at centers with higher procedural volumes was significantly associated with faster treatment times, better discharge outcomes, and lower rates of in-hospital mortality and SICH. <h3>Disclosures</h3> <b>R. Nogueira:</b> 1; C; Principal Investigators of the ‘Endovascular Therapy for Low NIHSS Ischemic Strokes (ENDOLOW)’ trial. Funding for this project is provided by Cerenovus. 2; C; Anaconda, Biogen, Cerenovus, Genentech, Philips, Hybernia, Imperative Care, Medtronic, Phenox, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, Synchron, Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse, Perfuze. 4; C; Viz-AI, Perfuze, Cerebrotech, Reist/Q’Apel Medical, Truvic, Vastrax, Viseon.