Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry

Raul G. Nogueira, Diogo C. Haussen, Alicia Castonguay, Leticia C. Rebello, Michael Abraham, Ajit Puri, Amer Alshekhlee, Aniel Majjhoo, Hamed Farid, Ira Finch, Joey English, Maxim Mokin, Michael T. Froehler, Mo Kabbani, Muhammad A. Taqi, Nirav Vora, Ramy El Khoury, Randall C. Edgell, Roberta Novakovic, Thanh NguyenVallabh Janardhan, Enrol Veznedaroglu, Shyam Prabhakaran, Ron Budzik, Michael R. Frankel, Brittany L. Nordhaus, Osama O. Zaidat

Research output: Contribution to journalArticle

Abstract

Background and Purpose- It remains unclear how experience influences outcomes after the advent of stent retriever technology. We studied the relationship between site experience and outcomes in the Trevo Acute Ischemic Stroke multicenter registry. Methods- The 24 sites that enrolled patients in the Trevo Acute Ischemic Stroke registry were trichotomized into low-volume (<2 cases/month), medium-volume (2-4 cases/month), and high-volume centers (>4 cases/month). Baseline features, imaging, and clinical outcomes were compared across the 3 volume strata. A multivariable analysis was performed to assess whether outcomes were influenced by site volumes. Results- A total of 624 patients were included and distributed as low- (n=188 patients, 30.1%), medium- (n=175, 28.1%), and high-volume (n=261, 41.8%) centers. There were no significant differences in terms of age (mean, 66±16 versus 67±14 versus 65±15; P=0.2), baseline National Institutes of Health Stroke Scale (mean, 17.6±6.5 versus 16.8±6.5 versus 17.6±6.9; P=0.43), or occlusion site across the 3 groups. Median (interquartile range) times from stroke onset to groin puncture were 266 (181.8-442.5), 239 (175-389), and 336.5 (221.3-466.5) minutes in low-, medium-, and high-volume centers, respectively (P=0.004). Higher efficiency and better outcomes were seen in higher volume sites as demonstrated by shorter procedural times (median, 97 versus 67 versus 69 minutes; P<0.001), higher balloon guide catheter use (40% versus 36% versus 59%; P≤0.0001), and higher rates of good outcome (90-day modified Rankin Scale [mRS], ≤2; 39% versus 50% versus 53.4%; P=0.02). There were no appreciable differences in symptomatic intracranial hemorrhage or 90-day mortality. After adjustments in the multivariable analysis, there were significantly higher chances of achieving a good outcome in high- versus low-volume (odds ratio, 1.67; 95% CI, 1.03-2.7; P=0.04) and medium- versus low-volume (odds ratio, 1.75; 95% CI, 1.1-2.9; P=0.03) centers, but there were no significant differences between high- and medium-volume centers (P=0.86). Conclusions- Stroke center volumes significantly influence efficiency and outcomes in mechanical thrombectomy.

Original languageEnglish (US)
Pages (from-to)2455-2460
Number of pages6
JournalStroke
Volume50
Issue number9
DOIs
StatePublished - Sep 1 2019
Externally publishedYes

Fingerprint

Registries
Stroke
Odds Ratio
Thrombectomy
Groin
Intracranial Hemorrhages
National Institutes of Health (U.S.)
Punctures
Stroke Volume
Stents
Catheters
Technology
Mortality

Keywords

  • brain ischemia
  • groin
  • humans
  • stents
  • thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Nogueira, R. G., Haussen, D. C., Castonguay, A., Rebello, L. C., Abraham, M., Puri, A., ... Zaidat, O. O. (2019). Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry. Stroke, 50(9), 2455-2460. https://doi.org/10.1161/STROKEAHA.118.024639

Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry. / Nogueira, Raul G.; Haussen, Diogo C.; Castonguay, Alicia; Rebello, Leticia C.; Abraham, Michael; Puri, Ajit; Alshekhlee, Amer; Majjhoo, Aniel; Farid, Hamed; Finch, Ira; English, Joey; Mokin, Maxim; Froehler, Michael T.; Kabbani, Mo; Taqi, Muhammad A.; Vora, Nirav; Khoury, Ramy El; Edgell, Randall C.; Novakovic, Roberta; Nguyen, Thanh; Janardhan, Vallabh; Veznedaroglu, Enrol; Prabhakaran, Shyam; Budzik, Ron; Frankel, Michael R.; Nordhaus, Brittany L.; Zaidat, Osama O.

In: Stroke, Vol. 50, No. 9, 01.09.2019, p. 2455-2460.

Research output: Contribution to journalArticle

Nogueira, RG, Haussen, DC, Castonguay, A, Rebello, LC, Abraham, M, Puri, A, Alshekhlee, A, Majjhoo, A, Farid, H, Finch, I, English, J, Mokin, M, Froehler, MT, Kabbani, M, Taqi, MA, Vora, N, Khoury, RE, Edgell, RC, Novakovic, R, Nguyen, T, Janardhan, V, Veznedaroglu, E, Prabhakaran, S, Budzik, R, Frankel, MR, Nordhaus, BL & Zaidat, OO 2019, 'Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry', Stroke, vol. 50, no. 9, pp. 2455-2460. https://doi.org/10.1161/STROKEAHA.118.024639
Nogueira RG, Haussen DC, Castonguay A, Rebello LC, Abraham M, Puri A et al. Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry. Stroke. 2019 Sep 1;50(9):2455-2460. https://doi.org/10.1161/STROKEAHA.118.024639
Nogueira, Raul G. ; Haussen, Diogo C. ; Castonguay, Alicia ; Rebello, Leticia C. ; Abraham, Michael ; Puri, Ajit ; Alshekhlee, Amer ; Majjhoo, Aniel ; Farid, Hamed ; Finch, Ira ; English, Joey ; Mokin, Maxim ; Froehler, Michael T. ; Kabbani, Mo ; Taqi, Muhammad A. ; Vora, Nirav ; Khoury, Ramy El ; Edgell, Randall C. ; Novakovic, Roberta ; Nguyen, Thanh ; Janardhan, Vallabh ; Veznedaroglu, Enrol ; Prabhakaran, Shyam ; Budzik, Ron ; Frankel, Michael R. ; Nordhaus, Brittany L. ; Zaidat, Osama O. / Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry. In: Stroke. 2019 ; Vol. 50, No. 9. pp. 2455-2460.
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TY - JOUR

T1 - Site Experience and Outcomes in the Trevo Acute Ischemic Stroke (TRACK) Multicenter Registry

AU - Nogueira, Raul G.

AU - Haussen, Diogo C.

AU - Castonguay, Alicia

AU - Rebello, Leticia C.

AU - Abraham, Michael

AU - Puri, Ajit

AU - Alshekhlee, Amer

AU - Majjhoo, Aniel

AU - Farid, Hamed

AU - Finch, Ira

AU - English, Joey

AU - Mokin, Maxim

AU - Froehler, Michael T.

AU - Kabbani, Mo

AU - Taqi, Muhammad A.

AU - Vora, Nirav

AU - Khoury, Ramy El

AU - Edgell, Randall C.

AU - Novakovic, Roberta

AU - Nguyen, Thanh

AU - Janardhan, Vallabh

AU - Veznedaroglu, Enrol

AU - Prabhakaran, Shyam

AU - Budzik, Ron

AU - Frankel, Michael R.

AU - Nordhaus, Brittany L.

AU - Zaidat, Osama O.

PY - 2019/9/1

Y1 - 2019/9/1

N2 - Background and Purpose- It remains unclear how experience influences outcomes after the advent of stent retriever technology. We studied the relationship between site experience and outcomes in the Trevo Acute Ischemic Stroke multicenter registry. Methods- The 24 sites that enrolled patients in the Trevo Acute Ischemic Stroke registry were trichotomized into low-volume (<2 cases/month), medium-volume (2-4 cases/month), and high-volume centers (>4 cases/month). Baseline features, imaging, and clinical outcomes were compared across the 3 volume strata. A multivariable analysis was performed to assess whether outcomes were influenced by site volumes. Results- A total of 624 patients were included and distributed as low- (n=188 patients, 30.1%), medium- (n=175, 28.1%), and high-volume (n=261, 41.8%) centers. There were no significant differences in terms of age (mean, 66±16 versus 67±14 versus 65±15; P=0.2), baseline National Institutes of Health Stroke Scale (mean, 17.6±6.5 versus 16.8±6.5 versus 17.6±6.9; P=0.43), or occlusion site across the 3 groups. Median (interquartile range) times from stroke onset to groin puncture were 266 (181.8-442.5), 239 (175-389), and 336.5 (221.3-466.5) minutes in low-, medium-, and high-volume centers, respectively (P=0.004). Higher efficiency and better outcomes were seen in higher volume sites as demonstrated by shorter procedural times (median, 97 versus 67 versus 69 minutes; P<0.001), higher balloon guide catheter use (40% versus 36% versus 59%; P≤0.0001), and higher rates of good outcome (90-day modified Rankin Scale [mRS], ≤2; 39% versus 50% versus 53.4%; P=0.02). There were no appreciable differences in symptomatic intracranial hemorrhage or 90-day mortality. After adjustments in the multivariable analysis, there were significantly higher chances of achieving a good outcome in high- versus low-volume (odds ratio, 1.67; 95% CI, 1.03-2.7; P=0.04) and medium- versus low-volume (odds ratio, 1.75; 95% CI, 1.1-2.9; P=0.03) centers, but there were no significant differences between high- and medium-volume centers (P=0.86). Conclusions- Stroke center volumes significantly influence efficiency and outcomes in mechanical thrombectomy.

AB - Background and Purpose- It remains unclear how experience influences outcomes after the advent of stent retriever technology. We studied the relationship between site experience and outcomes in the Trevo Acute Ischemic Stroke multicenter registry. Methods- The 24 sites that enrolled patients in the Trevo Acute Ischemic Stroke registry were trichotomized into low-volume (<2 cases/month), medium-volume (2-4 cases/month), and high-volume centers (>4 cases/month). Baseline features, imaging, and clinical outcomes were compared across the 3 volume strata. A multivariable analysis was performed to assess whether outcomes were influenced by site volumes. Results- A total of 624 patients were included and distributed as low- (n=188 patients, 30.1%), medium- (n=175, 28.1%), and high-volume (n=261, 41.8%) centers. There were no significant differences in terms of age (mean, 66±16 versus 67±14 versus 65±15; P=0.2), baseline National Institutes of Health Stroke Scale (mean, 17.6±6.5 versus 16.8±6.5 versus 17.6±6.9; P=0.43), or occlusion site across the 3 groups. Median (interquartile range) times from stroke onset to groin puncture were 266 (181.8-442.5), 239 (175-389), and 336.5 (221.3-466.5) minutes in low-, medium-, and high-volume centers, respectively (P=0.004). Higher efficiency and better outcomes were seen in higher volume sites as demonstrated by shorter procedural times (median, 97 versus 67 versus 69 minutes; P<0.001), higher balloon guide catheter use (40% versus 36% versus 59%; P≤0.0001), and higher rates of good outcome (90-day modified Rankin Scale [mRS], ≤2; 39% versus 50% versus 53.4%; P=0.02). There were no appreciable differences in symptomatic intracranial hemorrhage or 90-day mortality. After adjustments in the multivariable analysis, there were significantly higher chances of achieving a good outcome in high- versus low-volume (odds ratio, 1.67; 95% CI, 1.03-2.7; P=0.04) and medium- versus low-volume (odds ratio, 1.75; 95% CI, 1.1-2.9; P=0.03) centers, but there were no significant differences between high- and medium-volume centers (P=0.86). Conclusions- Stroke center volumes significantly influence efficiency and outcomes in mechanical thrombectomy.

KW - brain ischemia

KW - groin

KW - humans

KW - stents

KW - thrombectomy

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