Comparison of Endovascular Therapy Care and Outcome in Primary and Comprehensive Stroke Centers for Acute Ischemic Stroke in China A Real-World Nationwide Registry

Ting-yu Yi^1,2Shujuan Gan^3,4Meihua Wu^1,2Weifeng Huang⁵Yanmin Wu¹Hanming Tu⁶Changjun Yang⁷Lihua Xu⁸Hui Tan⁹Gao Lin¹⁰Shuguang Zhao¹¹Linping Wei¹²Yingchun Wu¹³Guiguan Yang¹⁴Jian Ye¹⁵Dongsheng Ju¹⁶Ya Shao¹⁷Zaihui Zhang¹⁸Junfeng Su¹⁹Shijun Zhao²⁰Weidong Huang²¹Xinshan Wu²²Dinglai Lin¹Xiaohui Lin¹ZhiNan Pan¹Xiufen Zheng¹Ganji Hong¹Rongcheng Chen¹Lisan Zeng¹Thanh N. Nguyen²³Xuesong Bai²⁴Liqun Jiao^24*Wen-huo Chen^4*

• ¹Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
• ²Zhangzhou Municipal Hospital of Fujian Province, Zhangzhou, China
• ³The Second Hospital of Zhangzhou, Zhangzhou, China
• ⁴Fujian Medical University Union Hospital, Fuzhou, China
• ⁵Fujian Medical University, Fuzhou, China
• ⁶Yongkang First People's Hospital, Zhejiang, China
• ⁷Sinan County People's Hospital of Guizhou province, Guizhou, China
• ⁸Jiamusi Central Hospital, Heilongjiang, China
• ⁹Taoyuan Country People's Hospital of Hunan province, Hunan, China
• ¹⁰Liaoning Provincial Health Industry Group Fukuang General Hospital, Fushun, China
• ¹¹Taihe County People's Hospital, Wuhu, China
• ¹²Longchuan County People's Hospital, Guangdong, China
• ¹³Ordos Center Hospital, Ordos, China
• ¹⁴Xingguo People's Hospital, Jiangxi, China
• ¹⁵Fuqing Hospital Affilited of Fujian Medical University, Fuqing, China
• ¹⁶Songyuan Jilin Oilfield Hospital, Jilin, China
• ¹⁷Gansu Provincial Hospital of Traditional Chinese Medicine, Lanzhou, China
• ¹⁸Xiu Yan People's Hospital, Liaoning, China
• ¹⁹Jingzhou Hospital Affiliated to Yangtze University, Hubei, China
• ²⁰Tangshanfengrun county people's hospital, Hebei, China
• ²¹Longhua County Hospital, Hebei, China
• ²²Bayinggolin Mongolian Autonomous Prefecture People's Hospital, Xinjiang, China
• ²³Boston University Chobanian & Avedisian School of Medicine, Boston, United States
• ²⁴Capital Medical University, Beijing, China

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, 1196 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 minutes vs. 268 minutes, p<0.001) but longer door-to-puncture time (DPT: 112 minutes vs. 95 minutes, 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). Conclusions: 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.