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Comprehensive versus thrombectomy-capable stroke centers: a web-based model to predict outcomes after mechanical
Shujuan Gan1,2, Weifeng Huang1, Tingyu Yi3
1Department of Cerebrovascular Disease, Fujian Medical University Union Hospital, Fujian, China.
Background:
The quality and clinical outcomes of mechanical thrombectomy (MT) performed at thrombectomy-capable stroke centers (TSCs) versus comprehensive stroke centers (CSCs) remain insufficiently characterized.
Objective:
To compare MT outcomes between TSCs and CSCs and to develop and externally validate an online tool for individualized prognosis and decision support.
Design:
Retrospective cohort study including derivation and external validation cohorts from multiple stroke centers.
Method:
Patients with anterior circulation large vessel occlusion who underwent MT within 24 h were analyzed. Inverse probability of treatment weighting (IPTW) and multivariable logistic regression estimated the effects of stroke center certification. Sensitivity analyses using alternative model specifications, patient subsets, and predefined subgroups assessed robustness and heterogeneity. A prognostic model was developed using least absolute shrinkage and selection operator regression after IPTW, externally validated using 2023-2024 data from different centers, and deployed as a Shiny-based online tool predicting 90-day modified Rankin Scale outcomes (0-2 for independence, 0-5 for survival).
Results:
The median age was 69 years (interquartile range (IQR) 60-77) in the derivation cohort (n = 975) and 72 years (IQR 64-80) in the validation cohort (n = 484). Functional outcomes and survival probabilities were similar between cohorts. After IPTW and adjustment, logistic regression showed CSCs were associated with higher 3-month survival (OR, 1.70 (95% CI: 1.31-2.22)). Sensitivity and subgroup analyses validated findings. The online prediction model, incorporating eight variables, demonstrated strong discriminative ability for functional outcomes (C-statistic 0.77 (95% CI: 0.73-0.81)) and survival (C-statistic 0.77 (95% CI: 0.71-0.82).
Conclusion:
CSCs were significantly associated with a higher probability of survival compared to TSCs, while no significant difference was observed in favorable functional outcomes. An online multivariable model could predict clinical outcomes and guide decision-making between TSCs and CSCs in routine clinical practice.
