Introduction: Endovascular stroke therapy has become the gold standard treatment for large vessel occlusion. The Joint Commission has certified hospitals as Comprehensive stroke centers (JCCSC) based on rigorous standards in the hopes of identifying centers of excellence. We sought to determine if JCCSC have faster door to reperfusion times compared to non-JCCSC.
Methods: The TREVO registry is a multicenter international real world registry assessing angiographic and clinical outcomes with the Trevo device being used in the first pass. We defined a CSC as certified by the Joint Commission as of July 1, 2016. Demographic information, times within the hospital, angiographic results and clinical outcomes were analyzed between the JCCSC and non-JCCSC institutions.
Results: A total of 507 patients (329 JCCSC, 178 non-JCCSC) have completed data in the Trevo registry to date. There are a higher proportion of patients with ASPECTS < 7 being treated at JCCSC vs. non-JCCSC (8.8% vs. 0.0%, p<0.02). There were no differences in outcomes, reperfusion rates or symptomatic hemorrhage rates between the two groups. Demographics were similar except patients treated at a JCCSC had a higher median NIHSS [17 vs. 15, p<0.003] compared to the non-JCCSC group. Median (IQR) door to puncture times did not differ between the two groups [85(57-132) vs. 91(59-137), p<0.96], but patients treated at a JCCSC had lower mean angiographic procedure times [59 ± 34 minutes vs. 66±44 minutes, p<0.05]. The analysis did not change when we looked at the subset of patients who were not transferred with anterior circulation strokes less than 8 hours from onset.
Conclusions: Patients treated at a JCCSC had faster procedural times, without faster door to procedure times when compared to non-JCCSC centers. Outcomes were no different, due to imbalances in stroke severity at baseline and a higher proportion of patients with ASPECTS < 7 being treated.