When More is Better: Article Commentary on “Effect of Cumulative Case Volume on Procedural and Clinical Outcomes in Endovascular Thrombectomy”
Kim BM, Baek J-H, Heo JH, Kim DJ, Nam HS, Kim YD. Effect of Cumulative Case Volume on Procedural and Clinical Outcomes in Endovascular Thrombectomy. Stroke. 2019;50:1178–1183.
Stroke thrombectomy is here to stay. We have enough evidence to treat anterior circulation strokes in different scenarios, and this evidence grows to go further, treating patients with worse ASPECTS score, longer evolution or older age. This implies increasingly complex patient management, and their assessment in experienced centers will be fundamental. The available literature suggests a powerful direct correlation between endovascular volume and outcomes, both for individual practitioners and for institutions.
With the aim of testing cumulative case volume (CCV) effect on clinical outcomes in stroke patients who underwent endovascular treatment(EVT), the authors included anterior circulation stroke, with intracranial internal carotid artery, M1 and proximal M2 occlusion from January 2011 to December 2015. Seventeen stroke centers participated in this study. Tandem atherosclerotic or dissecting cervical internal carotid artery occlusion accompanied by intracranial large vessel occlusion (LVO) was included. Multifocal LVO (bilateral anterior or involvement of both anterior and posterior circulations) was excluded. Eligible patients received intravenous tPA. EVT was performed under local anesthesia with or without conscious sedation. Stentriever (SR) or contact aspiration (CA) were used for EVT. Two neuroradiologists independently assessed the images for Alberta Stroke Program Early Computed Tomography Score, and 2 interventional neuroradiologists independently assessed whether recanalization was achieved on the catheter angiograms. The reviewers were blind to the clinical outcome. Recanalization success was defined as modified Thrombolysis In Cerebral Ischemia grade 2b or 3 on the final control angiogram. A good outcome was defined as modified Rankin Scale of 0 to 2 at 3 months.