Significant impact of implementing thrombectomy in Spanish stroke centres

The implementation of endovascular thrombectomy (EVT) facilities in stroke centres in densely populated areas outside the city of Barcelona has significantly enhanced access to endovascular treatment, increasing treatment rates and admission and onset to puncture (ATP, OTP) time without compromising safety standards or reperfusion outcomes. It has been achieved with clinically relevant improvements in functional outcomes.

“In Catalonia, population density has large disparities in geographic distribution, with extensive rural areas with a very low population density. When EVT was introduced, at first the procedure was only performed in the Barcelona metropolitan area, covering approximately half of Catalonia's population, explained Dr Jordi Mayol. Patients living relatively far from Barcelona received less endovascular treatment and had worse time metrics and functional outcomes. Since then, centres performing EVT have been established in the more densely populated areas far from Barcelona.

Dr Mayol and colleagues set up a study to evaluate whether implementing stroke centres performing EVT in densely populated areas far from Barcelona could improve stroke care metrics [1]. This population-based study focused on outcomes of acute stroke patients within the catchment area of 3 primary stroke centres that transitioned to thrombectomy-capable centres. The proportion of patients treated with EVT and intravenous treatment (IVT), complete reperfusion, symptomatic intracranial haemorrhage (sICH) and time from ATP were compared before (Jan 2017 - June 2020) and after (July 2020 - December 2023). The 2 cohorts were matched with propensity score matching. The primary outcome was functional status assessed with mRS after 90 days.

The propensity score matching procedure retrieved 859 pairs. Patients had significantly better mRS in the post-implementation period after 90 days. The proportion of participants treated with EVT increased from 391 (67%) before the implementation to 471 (80.2%) after the implementation (OR 2.035; 95% CI 1.563–2.660; see figure), while patients treated with IVT decreased (OR 0.710; 95% CI: 0.564-0.893).

Figure: Proportion of vessel occlusions treated with thrombectomy [1]



There was a decrease in the time from first ATP and OTP of 65 and 45 minutes (95% CI 46-77, 17-75). Endovascular treatment was performed without a significant increase in symptomatic sICH and with similar rates of complete reperfusion.

1. Mayol J. Clinical impact of endovascular treatment implementation in primary stroke centers of Catalonia. OPR-021, EAN Congress 2025, 21-24 June, Helsinki, Finland.

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Posted on 3 September 20253 September 2025