Comprehensive versus thrombectomy-capable stroke centers: a web-based model to predict outcomes after mechanical...

Area of Science:

• Neurology
• Interventional Cardiology
• Public Health

Background:

• Outcomes of mechanical thrombectomy (MT) at thrombectomy-capable stroke centers (TSCs) versus comprehensive stroke centers (CSCs) require further clarification.
• Characterizing the differences in clinical outcomes between TSCs and CSCs is crucial for stroke care optimization.

Purpose of the Study:

• To compare the clinical outcomes of mechanical thrombectomy (MT) performed at TSCs versus CSCs.
• To develop and validate an online prognostic tool for individualized decision support in stroke care.

Main Methods:

• Retrospective cohort study with derivation and external validation cohorts.
• Inverse probability of treatment weighting (IPTW) and multivariable logistic regression were used to analyze MT outcomes.
• A prognostic model was developed and externally validated, then deployed as an online tool to predict 90-day modified Rankin Scale outcomes.

Main Results:

• Comprehensive stroke centers (CSCs) were associated with significantly higher 3-month survival rates compared to thrombectomy-capable stroke centers (TSCs) (OR, 1.70).
• No significant differences in favorable functional outcomes were observed between CSCs and TSCs.
• The developed online prediction model demonstrated strong discriminative ability for both functional outcomes and survival (C-statistic 0.77).

Conclusions:

• Comprehensive stroke centers (CSCs) are associated with improved survival probability following mechanical thrombectomy (MT) compared to TSCs.
• An online multivariable prediction model can effectively guide clinical decision-making regarding stroke center choice and patient prognosis.
• The findings support the utility of CSCs for optimizing mechanical thrombectomy outcomes.