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Updated: May 13, 2025
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
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.
Insights
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.
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.
Background:
To maintain procedural proficiency and certification according to the standards set by The Joint Commission-which accredits health care centers in the United States-thrombectomy-capable stroke centers (TSCs) must achieve a minimum annual procedural volume. The addition of thrombectomy-capable centers in a regional stroke care system has the potential to increase access but also to decrease patient presentations and procedural volume at nearby centers. This study sought to characterize the impact of certifying additional thrombectomy-capable centers on procedural volume by center in a large, urban Emergency Medical Services (EMS) system.
Methods:
Data were collected from each designated thrombectomy-capable center in Los Angeles (LA) County from January 1, 2018 through June 30, 2022, during which a net total of five thrombectomy-capable centers were newly designated in the County. Per center volume for ischemic stroke presentations, intravenous (IV) thrombolysis administrations (IV tissue plasminogen activator [tPA]), and thrombectomy were tabulated by six-month interval. Median last-known-well-to-procedure times by LA County Public Health service planning area (SPA) were calculated. The effect of the number of designated centers on procedural volumes per center and median last-known-well-to-procedure times were analyzed via a linear mixed effects model with a log link function.
Results:
Procedural volume, ischemic stroke presentation volume, and last-known-well-to-procedure times had high variability over the time period studied. Nonetheless, the median values for each metric in this EMS system remained largely stable over the study period. There was no statistically significant association between the number of thrombectomy-capable centers and per center procedural volumes or times-to-procedure.
Conclusion:
The designation of additional thrombectomy-capable centers in a regional stroke care system was not significantly associated with the volume of procedures by center or times-to-procedure, suggesting that additional centers may increase patient access to time-sensitive interventions without diluting patient presentations at existing centers.
