IntroductionSeveral studies have addressed technical aspects of endovascular thrombectomy (EVT), but it is not well known how procedural factors contribute to technical success in routine healthcare. The aim was to explore factors associated with technically successful EVT on nationwide scale.MethodsWe did an observational register-based study assessing factors associated with technical success off anterior circulation EVT in Sweden. The main outcome was successful recanalization defined as modified treatment in cerebral ischemia score 2b-3. The association between baseline and treatment variables and successful recanalization were explored using Chi-square(d) test and univariable logistic regression. Multivariable logistic regression was used to define predictors of successful recanalization.ResultsThe study included 3211 patients treated during 2015 to 2020. Successful recanalization was achieved in 83.1% (2667) with a gradual improvement in technical outcome over the period. After adjustment for age and occlusion location, thet use of general anesthesia, balloon guide catheter (BGC) and an operator with an overall success rate of >85% were independent predictors of successful recanalization. An overall operator success rate of <80% or 80–85%, and an annual center volume lower than 50 were predicitors of recanalization failure.ConclusionThis study illustrates factors associated with procedural success in endovascular thrombectomy on a nationwide scale including the use of general anesthesia, BGC, annual center volumes >50 cases per year and the overall success rate of the individual operator. It highlights the potential benefit of systematic performance measurements, benchmarking, and continuous training to bring all centers and operators to the highest level of performance.

中文翻译：

---

与接受血管内血栓切除术治疗的急性缺血性卒中患者成功再通相关的操作因素——一项基于登记的全国性观察性研究

简介几项研究已经解决了血管内血栓切除术 (EVT) 的技术问题，但尚不清楚手术因素如何有助于常规医疗保健的技术成功。目的是探索与全国范围内 EVT 技术成功相关的因素。方法我们在瑞典进行了一项基于观察登记的研究，评估与前循环 EVT 技术成功相关的因素。主要结果是成功的再通，定义为脑缺血评分 2b-3 的改良治疗。使用卡方（d）检验和单变量逻辑回归探讨基线和治疗变量与成功再通之间的关联。使用多变量逻辑回归来定义成功再通的预测因素。结果该研究纳入了 2015 年至 2020 年期间接受治疗的 3211 名患者。83.1%（2667 名）实现了成功再通，在此期间技术成果逐渐改善。调整年龄和闭塞位置后，全身麻醉、球囊引导导管 (BGC) 和总体成功率 >85% 的操作者的使用是成功再通的独立预测因素。总体手术成功率<80%或80-85%，以及年度中心体积低于50是再通失败的预测因素。结论这项研究说明了与全国范围内血管内血栓切除术手术成功相关的因素，包括使用全身麻醉、BGC、每年中心数量 > 50 例以及个体操作员的总体成功率。它强调了系统绩效测量、基准测试和持续培训的潜在好处，可以使所有中心和操作员达到最高绩效水平。