Technical and Clinical Outcomes at a Thrombectomy-Capable Stroke Center in Poland in the Context of the Center’s Growing Experience, Expanding Treatment Guidelines and the Rise in Acute Ischemic Stroke Patient Volume: A Comparative Analysis of Initial and Subsequent Endovascular Procedures

TL;DR

This study examines how a stroke center in Poland improved outcomes for stroke patients over time, even as patient numbers and treatment complexity increased.

Contribution

The study provides empirical evidence on the performance of a thrombectomy-capable stroke center in Poland as it evolves and adapts to new treatment models and operator experience.

Findings

Significant improvements in time metrics and procedural efficiency were observed in later-treated patients.

The drip-and-ship model showed longer time intervals compared to direct admission.

Extended time window patients had lower IVT rates but similar clinical outcomes and complication rates.

Abstract

(1) Introduction. To improve access times and provide effective treatment to the growing patient population with acute stroke due to large vessel occlusion (LVO), thrombectomy-capable stroke centers (TCSCs) should be made an integral part of hospital infrastructure in Poland. The geographical proximity of thrombectomy-capable centers and recently extended treatment time windows will considerably increase patient numbers, decrease patient disability, and reduce the costs of long-term care. (2) Aim of the study. This study investigates the clinical outcomes, time metrics, and angiographic data of a cohort containing 250 thrombectomy patients at a single TCSC in Poland. We measured performance against data from the national database during two crucial time intervals: at the very beginning of the center’s service and after the involvement of a new operator. This study considers concurrent modifications in qualification guidelines, the TCSC’s transition from a ‘direct-admission-only’ to a ‘drip-and-ship’ model, and the learning curve of the interventional stroke team. (3) Methods. A retrospective analysis was conducted on 250 patients treated from August 2020 to May 2025 at a newly established TCSC. The cohort was dived into 2 subgroups: an initial group of 100 patients, whose treatment corresponded to the involvement of a new, previously trained on-site operator and the establishment of 24/7 service, and a group of 150 patients who received later treatment. Additional comparisons were made between a cohort of directly admitted patients and those treated under the drip-and-ship model. The results compared between patients treated with early and expanded time windows. (4) Results. Significant differences were observed between the first 100 and subsequent 150 patients in terms of admission scheme (97% vs. 70%, p < 0.0001), extended time window treatment (8% vs. 17.3%, p < 0.05), and intravenous thrombolysis treatment (81% vs. 65.3%, p < 0.01). Improvements in time intervals and procedural factors were noted in the second group, reflecting the operator’s increased experience (groin-to-first pass time: 27 vs. 23 min, p < 0.05). A comparative analysis between the direct admission and drip-and-ship models revealed extended time intervals in the latter (door-to-groin: 110 vs. 159 min, p < 0.001; door-to-recanalization: 158 vs. 200 min, p < 0.001; door-to-CT: 9 vs. 16.5 min, p < 0.001; and door-to-IVT: 21 vs. 43 min, p < 0.001). Patients in the extended time window exhibited lower intravenous thrombolysis rates (78.2% vs. 29.4%, p < 0.0001) and prolonged door-to-groin (117.5 vs. 150 min, p < 0.005), door-to-CT (10 vs. 19.5 min, p < 0.01), and door-to-IVT (25 vs. 77.5 min, p < 0.001) times. No significant differences were found in complication rates, clinical outcomes, or mortality between the analyzed subgroups. (5) Conclusions. The present data demonstrate favorable clinical and angiographic results among acute LVO stroke patients at the newly established TCSC, both at the onset of the mechanical thrombectomy service and after the involvement of a newly trained operator. Even when treating patients with prolonged times due to transportation and late window qualification, we observed favorable clinical outcomes and low rates of complications. The results achieved in our TCSC compared with the national data suggest that TCSCs could potentially play an important role within the overall endovascular treatment system for acute ischemic stroke patients in Poland.