Author + information
- Received October 2, 2018
- Revision received November 26, 2018
- Accepted December 4, 2018
- Published online February 18, 2019.
- Rody El Nawar, MDa,b,
- Bertrand Lapergue, MD, PhDc,d,
- Michel Piotin, MD, PhDe,
- Benjamin Gory, MD, PhDf,g,h,
- Raphael Blanc, MD, MSce,
- Arturo Consoli, MDi,
- Georges Rodesch, MD, PhDi,
- Mikael Mazighi, MD, PhDe,j,k,
- Frederic Bourdain, MDc,
- Maéva Kyheng, BSTl,
- Julien Labreuche, BSTl,
- Fernando Pico, MD, PhDa,d,k,∗ (, )
- on behalf of the ETIS Investigators
- aDepartment of Neurology and Stroke Center, Centre Hospitalier de Versailles, Versailles, France
- bGilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
- cDepartment of Neurology and Stroke Center, Hospital Foch, Suresnes, France
- dVersailles Saint-Quentin en Yvelines and Paris Saclay University, Versailles, France
- eDepartment of Interventional Neuroradiology, Rothschild Foundation, Paris, France
- fDepartment of Interventional Neuroradiology, Hospices Civils de Lyon, Lyon, France
- gDepartment of Diagnostic and Therapeutic Neuroradiology, University Hospital of Nancy, Nancy, France
- hUniversity of Lorraine, INSERM U1254, IADI, Nancy, France
- iDepartment of Diagnostic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
- jParis Denis Diderot University, Paris, France
- kINSERM LVTS (Laboratory for Vascular Translational Science)-1148, Paris, France
- lLille University, CHU Lille, EA 2694 - Santé publique: épidémiologie et qualité des soins, Lille, France
- ↵∗Address for correspondence:
Pr. Fernando Pico, Department of Neurology and Stroke Center, Centre Hospitalier de Versailles, 177 Rue de Versailles, Versailles Saint-Quentin en Yvelines et Paris Saclay University, 78150 Le Chesnay, Versailles, France.
Objectives The aim of this study was to determine whether individual operator characteristics have an impact on reperfusion and procedural complication rates.
Background Mechanical thrombectomy (MT) is a Level IA treatment in acute ischemic stroke (AIS) patients. The operator’s effect has been found to be an independent predictor for clinical outcome and technical performance in interventional cardiology.
Methods From the ETIS (Endovascular Treatment in Ischemic Stroke) study, a prospective, multicenter, observational real-world MT registry, the authors included all AIS patients consecutively treated by MT between January 2012 and March 2017 in 3 high-volume comprehensive stroke centers by 19 operators. We assessed the effect of individual operator characteristics on successful reperfusion, defined as modified Thrombolysis In Cerebral Infarction 2b/3 at the end of MT, and procedural complications using multivariable hierarchical logistic regression models.
Results A total of 1,541 patients with anterior and posterior AIS were enrolled (mean age 67 years; median NIHSS 16). There was a significant operator effect on successful reperfusion, with an intraclass correlation coefficient of 0.036 (p = 0.046), but not on complications (intraclass correlation coefficient = 0). There was a dose–response relationship between annual operator volume and successful reperfusion rate (p = 0.003) with an adjusted odds ratio for successful reperfusion equal to 2.52 (95% confidence interval: 1.37 to 4.64) for patients treated by an operator with an annual volume ≥40 MT/year compared with those treated by an operator with <14 MT/year (first tertile). Nevertheless, this result did not translate to better clinical outcomes.
Conclusions Our data suggest that operator volume of MT/year has a positive impact on successful reperfusion in AIS patients, but not on clinical outcomes nor on complication rates. Further studies are warranted to investigate threshold procedure numbers associated with better outcomes.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 2, 2018.
- Revision received November 26, 2018.
- Accepted December 4, 2018.
- 2019 American College of Cardiology Foundation
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