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Related Concept Videos

Regulation of Stroke Volume01:27

Regulation of Stroke Volume

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The regulation of stroke volume, which is the amount of blood the heart pumps out during each heartbeat, is critical for maintaining a healthy circulatory system. Stroke volume is influenced by three main factors: preload, contractility, and afterload.
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling...
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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Does Adding Thrombectomy-Capable Stroke Centers in a Regional Stroke Care System Affect Procedural Volume?

Juliana Tolles1,2, Jake Toy1,2,3, Patrick Lyden4

  • 1Department of Emergency Medicine, Harbor-UCLA Medical Center & The Lundquist Institute, Torrance, CaliforniaUSA.

Prehospital and Disaster Medicine
|April 16, 2025
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Adding more stroke thrombectomy centers did not reduce patient volumes or procedure times at existing centers. This suggests increased access to time-sensitive stroke interventions without negatively impacting established facilities.

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large vessel occlusionregional carestroketPAthrombectomy

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Area of Science:

  • Neurology
  • Public Health
  • Healthcare Systems

Background:

  • Thrombectomy-capable stroke centers (TSCs) require minimum procedural volumes for certification by The Joint Commission.
  • New TSC designations can increase access but may decrease patient volume at existing centers.
  • Understanding the impact of TSC expansion on procedural volumes is crucial for regional stroke care planning.

Purpose of the Study:

  • To analyze the effect of newly designated TSCs on procedural volumes at existing centers within a large urban Emergency Medical Services (EMS) system.
  • To assess changes in ischemic stroke presentations, intravenous thrombolysis, and thrombectomy volumes per center.
  • To evaluate the impact on last-known-well-to-procedure times.

Main Methods:

  • Data from Los Angeles County TSCs (Jan 2018-June 2022) were analyzed, coinciding with five new TSC designations.
  • Per-center procedural volumes and last-known-well-to-procedure times were tabulated by six-month intervals.
  • Linear mixed-effects models were used to analyze the association between the number of TSCs and procedural metrics.

Main Results:

  • Procedural volumes and times-to-procedure showed high variability but remained largely stable in median values.
  • No statistically significant association was found between the number of TSCs and per-center procedural volumes.
  • No significant association was observed between the number of TSCs and times-to-procedure.

Conclusions:

  • Designating additional TSCs did not significantly affect procedural volumes or times at existing centers.
  • Expansion of TSCs may enhance patient access to critical stroke interventions without compromising established centers.
  • Regional stroke care systems can potentially integrate new centers without diluting patient flow.