Comparison of endovascular therapy care and outcome in primary and comprehensive stroke centers for acute ischemic stroke in China a real-world nationwide registry

Background and purpose Endovascular treatment (EVT) is a standard therapy for acute ischemic stroke (AIS) caused by large vessel occlusion (LVO). However, the performance of EVT in primary stroke centers (PSCs) in China remains uncertain. This study aims to explore the performance of EVT in PSCs and compare it with that in comprehensive stroke centers (CSCs). Methods We conducted a prospective registry of EVT at 11 CSCs and 26 PSCs in China. AIS patients with intracranial LVO who received EVT were divided into two groups based on the type of stroke center. We compared the AIS workflow, EVT procedural details, radiological, and clinical outcomes between the two groups. Results From November 2021 to December 2022, 1,196 patients were enrolled, and 847 were included in the analysis. Overall, 84.8% of patients achieved successful reperfusion, and 46.3% achieved good clinical outcomes. Compared with patients treated at CSCs, those treated at PSCs had shorter onset-to-presentation time (OPT: 152 min vs. 268 min, p < 0.001) but longer door-to-puncture time (DPT: 112 min vs. 95 min, p < 0.001). Successful reperfusion rates were lower in PSCs (76.6% vs. 91.0%, p < 0.001), and mortality was higher (24.7% vs. 14.4%, p < 0.001). However, good clinical outcomes were similar between the two groups (44.3% vs. 47.8%, p = 0.309). Conclusion In China, successful reperfusion rates were lower and mortality rates were higher despite shorter onset-to-presentation times in primary stroke centers. Additionally, door-to-puncture times were prolonged despite limited use of advanced brain imaging. These findings highlight the need for EVT skill training and improvement in the AIS workflow in primary stroke centers to enhance patient outcomes.