According to a study published online in the Journal of NeuroInterventional Surgery, patients who attend stroke centers with a high volume of patients are treated faster and have better outcomes.

Findings from the study are based on 442 patients with the average age of 66, treated with endovascular therapy at 9 specialist (tertiary) stroke centers between September 2009 and July 2011.

Endovascular therapy breaks down clots without the need for surgery.

All study participants arrived at the centers within 8 hours of the start of their symptoms.

According to the researchers, all the patients stroke was caused by a blood clot in a major brain artery which cut off blood supply.

The team gathered data on risk factors likely to influence the success of treatment, such as high cholesterol, diabetes, high blood pressure and abnormal heart rhythms (atrial fibrillation), as well as information on age and sex.

In addition, the researchers examined the size and location of the clot, how quickly treatment was administered, as well as how fast blood flow returned to normal (repercussion).

They found that it took on average 95 minutes from the start of treatment to completion of the procedure. After a CT scan of the brain was performed, a catheter was inserted through the groin and the clot buster drug was injected into the affected artery.

The team then set out to determine whether the stroke centers performed over 50 such procedures a year (high volume facilities).

They found that 49% of patients were treated in under 85 minutes and that the majority (80%) received treatment at a high volume center. The remaining 20% of patients received treatment at low volume centers.

After examining only patients referred from within the hospital, the team found that only 20 of the 112 patients who received treatment at the low volume center would have met the recommend 120 minute door to need time compared to 40 out of 100 patients at high volume centers. This 120 min window is considered vital for increasing survival chances.

52% of patients were transferred from another hospital. The researchers found that although there was no difference in procedure times between patients transferred from another hospital and those referred from within the same facility, they were treated faster.

More patients from other facilities were referred to a high volume center, where their probability of receiving clot-busting drugs was higher and they were more likely to receive faster treatment.

Patients treated at high volume centers were 82% more likely to have blood flow successfully restored in the affected artery and were 86% more likely to survive. According to the researchers, for every 30 minutes of delay, the survival rate decreased by 12%.

They conclude:

“Centers that currently perform higher numbers of [endovascular stroke] procedures appear to have lower times to reperfusion, and a higher proportion of patients with successful reperfusion, translating into improved clinical outcomes.”

Written By Grace Rattue