Background and Purpose: Mechanical thrombectomy (MT) is a level IA treatment in the acute phase of ischemic stroke (IS)1. The operator’s effect have been found to be an independent predictor of the outcome in interventional cardiology for STEMI syndromes2,4. The aim of this study was to analyse if operator characteristics have an impact on reperfusion and complications rates.

Methods: From the ETIS study, a prospective, multicenter, observational real world MT registry, we included 1541 IS patients consecutively treated by MT between January 2012 and March 2017 in 3 high volume MT centers by 19 operators. We assessed the effect of individual operator on successful reperfusion (defined as a modified thrombolysis in cerebral infarction (2b/3)) and procedural complications (acquired new embolic territory infarction, arterial perforation and dissection) using a multivariable hierarchical logistic regression models.

Results: A total of 1541 anterior and posterior stroke patients were enrolled (mean age 67 years; median NIHSS 16). After controlling patient’s characteristics, there is a significant operator effect on successful reperfusion, with an intraclass correlation coefficient (ICC) of 0.036 (p=0.046)) but not on complications (ICC=0). There was a dose response relationship between annual operator volume and successful reperfusion (p=0.003). Compared with patients treated by operator with annual volume <14 MT, the adjusted odds ratio (95% confidence interval) for successful reperfusion was 1.75 (1.02 to 2.99) for patients treated by an operator with annual volume between 14 and 39 MT and 2.52 (1.37 to 4.64) for patients treated by an operator with annual volume ≥40 MT

Conclusions: Our data suggested that successful reperfusion in IS patients treated with MT was dependent on operator volume of MT per year.

HIGHER ANNUAL OPERATOR VOLUME IS ASSOCIATED WITH BETTER REPERFUSION RATES IN STROKE PATIENTS TREATED BY MECHANICAL THROMBECTOMY IN THE ETIS REGISTRY