AUTHOR=Yi Ting-yu , Gan Shujuan , Wu Meihua , Huang Weifeng , Wu Yanmin , Tu Hanming , Yang Changjun , Xu Lihua , Tan Hui , Gao Lin , Zhao Shuguang , Wei Linping , Wu Yingchun , Yang Guiguan , Ye Jian , Ju Dongsheng , Shao Ya , Zhang Zaihui , Su Junfeng , Zhao Shijun , Huang Weidong , Wu Xinshan , Lin Dinglai , Lin Xiaohui , Pan ZhiNan , Zheng Xiufen , Hong Ganji , Chen Rongcheng , Zeng Lisan , Nguyen Thanh N. , Bai Xuesong , Jiao Liqun , Chen Wen-huo 

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

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1655954

DOI=10.3389/fneur.2025.1655954

ISSN=1664-2295

ABSTRACT=Background and purposeEndovascular 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).MethodsWe 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.ResultsFrom 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).ConclusionIn 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.