Ischemic Stroke Has Better Outcomes at Comprehensive and Thrombectomy-Capable Stroke Centers

Individuals with ischemic strokes were more likely to be discharged home or to rehabilitation centers after they received care at Comprehensive Stroke Centers (CSC) or Thrombectomy-capable Stroke Centers (TSC). Stroke care at CSC and TSC was delivered more promptly than at Primary Stroke Centers (PSC) (hospitals with the necessary resources to manage patients with acute ischemic stroke). 

Researchers compared outcomes and quality of care indicators for 84,903 participants (median age 70, 49.2% women) with ischemic stroke treated between 2018 and 2020 at stroke centers participating in the Get With The Guidelines (GWTG) Stroke Registry. 

Even though participants cared for in CSC and TSC were more likely to have severe strokes, they were also more likely to have their blood flow successfully restored after endovascular thrombectomy (EVT) compared with those treated at PSCs. Fewer participants treated at CSCs and TSCs died or were discharged to hospice than PSC participants. Overall, there was no significant difference in outcomes between CSC and TSC.

“Certification status of the center where a stroke patient receives care matters, and it’s important to know that the specific requirements to become a CSC or TSC are validated by these data. The quality of care is higher in these centers, as also confirmed by our findings,” said Radoslav Raychev, MD, FAHA, lead author of the study and a vascular and interventional neurologist and assistant professor of neurology at University of California, Los Angeles.

“TSC is a relatively new designation, introduced in 2018 by the accreditation agencies in cooperation with the American Heart Association/American Stroke Association,” Raychev said. “This is the first study to include the new thrombectomy-capable designation when comparing outcomes in the treatment of ischemic stroke at the different levels of stroke centers.”

The patients treated at TSCs and CSCs tended to have more severe strokes. The study analyzed 185 CSCs, 29 TSCs and 169 PSCs in the registry. As part of their treatment, each patient had received either intravenous clot-busting medication or EVT to restore blood flow in a blocked artery.

Researchers suggest PSC, that meet volume requirements should consider quality improvement efforts to advance certification to either a CSC or TCS.

“Our data indicates that nearly one-quarter of all EVTs in the United States are being performed in Primary Stroke Centers. This is unfortunate because PSCs are not required to have close oversight and implementation of EVT-specific American Stroke Association standards. We hope that clinicians recognize the importance of the certification status and its impact on the quality of acute stroke care, and we hope they advocate for appropriate changes within their institutions,” Raychev said.