Influence of hospital capabilities and prehospital time on outcomes of thrombectomy for stroke in Japan from 2013 to 2016
Authors: Kurogi Ai , Onozuka Daisuke , Hagihara Akihito , Nishimura Kunihiro , Kada Akiko , Hasegawa Manabu , Higashi Takahiro , Kitazono Takanari , Ohta Tsuyoshi , Sakai Nobuyuki , Arai Hajime , Miyamoto Susumu , Sakamoto Tetsuya , Iihara Koji ,   the J-ASPECT Study Collaborators, Takigami Masayoshi , Kamiyama Kenji , Houkin Kiyohiro , Nishi Shogo , Kaneko Sadao , Oka Koji , Nakagaki Yusuke , Ooyama Hiroshi , Takizawa Katsumi , Tokumitsu Naoki , Suzuki Susumu , Suzuki Nozomi , Kimura Teruo , Izumi Naoto , Nitta Kazumi , Ohtaki Masafumi , Isobe Masanori , Nishiya Mikio , Kaijima Mitsunobu , Mabuchi Syouji , Ogasawara Kuniaki , Kubo Naohiko , Shimizu Yukihiko , Saito Keiichi , Yamanome Tatumi , Yabuta Akinori , Yoshino Atsuo ,   N.A. (physician name not available), Harashina Junichi , Shimoda Masami , Jimbo Hiroyuki , Murakami Hideki , Masaoka Hiroyuki , Ohtaka Hirotoshi , Yoshida Hiroki , Suzuki Ichiro , Kohno Michihiro , Arai Yoshinori , Isoshima Akira , Hokari Mitsuhiko , Kawai Kensuke , Maehara Taketoshi , Arai Hajime , Kawamata Takakazu , Noguchi Makoto , Hoshino Haruhiko , Hiyama Hirofumi , Yoshida Kensaku , Fujitsuka Mitsuyuki , Takeda Yasuaki , Karasudani Hirohide , Kobayashi Shiro , Nakamura Michio , Ono Junichi , Suda Sumio , Hadeishi Hiromu , Wakui Kenji , Tanno Hirokazu , Sato Naoaki , Sakai Hideki , Matsumoto Takashi , Koketsu Naoki , Nakahara Ichiro , Hasegawa Toshinori , Kuwayama Naoto , Mizutani Nobuhiko , Suzaki Noriyuki , Yasui Keizo , Ikeda Akira , Takeuchi Youtarou , Wakabayashi Toshihiko , Tanaka Hisashi , Yoshimoto Junpei , Koichiro Ogura ,   N.A. (physician name not available), Yokoe Toshio ,   N.A. (physician name not available), Murao Kenichi , Yamada Tomonori , Kato Amami , Wakayama Akatsuki , Kataoka Hiroharu , Iwatsuki Kouich , Nakajima Yoshikazu , Gi Hidefuku , Uranishi Ryunosuke , Nakamura Yusaku , Yamanaka Kazunori , Matsumoto Hiroyuki , Fujiwara Hiroaki , Iwai Yoshiyasu , Morikawa Masashi ,   N.A. (physician name not available), Tane Kazuyuki , Hashikawa Kazuo , Yoneda Shunichi , Yamashita Kohsuke , Kitano Masahiko , Nakamura Kazuhito , Kono Katsuhiko , Ohata Kenji , Kuroiwa Toshihiko , Maeno Kazusige , Arai Motohiro , Iwase Masaaki , Hashimoto Kenji , Tsuruno Takashi , Kurokawa Shinichiro , Matsuyama Takeshi , Yuguchi Takamichi , Teramoto Yoshihumi , Matsuo Takayuki ,   N.A. (physician name not available), Kitagawa Naoki , Kaminogo Makio , Sakamoto Seisaburo , Tokunaga Yoshiharu , Urasaki Ei-Ichirou , Kuratsu Junichi , Takada Akira , Hasegawa Shu , Nishi Toru , Fuwa Isao , Tsuiki Hiromasa , Tsuiki Hiromasa , Koga Kazunari , Egami Hiroshi , Kawamura Tadao , Goda Makoto , Takeda Yu , Nagai Yasuyuki , Morisige Masaki , Yamaguchi Yutaka , Miyata Shiro , Takeshima Hideo , Yatsushiro Kazutaka , Ohta Hajime , Hirahara Kazuho , Kawano Teruaki , Obara Souichi , Seto Hiroshi , Tanaka Shunichi , Moroki Koiti , Arita Kazunori , Ishiuchi Shogo , Uchihara Toshimitsu , Mekaru Susumu , Nagamine Tomoaki , Momoji Jin , Yamamoto Satoshi , Kimoto Atusi , Kadekaru Tsutomu , Saito Akihiko , Onodera Osamu , Takahashi Hideaki , Arai Hiroyuki , Takeuchi Shigekazu , Takano Hiroki , Fukuda Osamu , Kouno Mitsuo , Michitoku Igarashi , Kubo Michiya , Hondo Hiroaki , Tadao Miyamori , Masuda Ryouichi , Hisashi Takata , Masuoka Toru ,   N.A. (physician name not available), Shirasaki Naoki , Nitta Hisashi , Kimura Makoto , Minamide Hisato , Shiraga Shunsuke , Nakada Mitsutoshi , Sato Shuji , Toda Hiroki , Yamamura Osamu , Kabuto Masanori , Hayashi Jyunya ,   N.A. (physician name not available), Kinouchi Hiroyuki , Shinohara Toyoaki , Koizumi Hidehito , Uchida Mikito , Imae Syougo , Ozawa Hiroshi , Nishizaki Osamu , Suga Masakazu , Kohno Kanehisa , Zenke Kiichiro , Sadashima Hiromichi , Mizobuchi Hikaru , Hayashi Satoru , Morimoto Masanori , Kohno Takeshi , Ueba Tetsuya , Nishimura Hiroyuki ,   N.A. (physician name not available), Shirakawa Norihito , Kagawa Masahiro , Hayashi Naoki , Shindo Atsushi , Yoshino Kimihiro , Masaoka Tetsuya , Hospital Kenwakai Otemati , Nakahara Ichiro , Nakamizo Akira , Okamoto Yuji , Kin Shigenari , Takahashi Haruki , Suzuki Satoshi , Iihara Koji , Hirakawa Katsuyuki , Nakamizo Akira , Ookura Akio , Matsukado Koichirou , Yoshida Hidenori , Nakane Hiroshi , Inoue Isao , Hisada Kei , Hitotsumatsu Tsutomu , Kuramoto Kouichi , Hayashi Junya , Ooishi Hiromichi , Nonaka Masani , Morioka Motohiro , Tsukamoto Haruhisa , Sugimori Hiroshi , Ishihara Shinichirou , Momozaki Nobuaki , Miyazono Masayuki , Nemoto Akihiro , Hirota Nobuo , Tanaka Hiroaki ,   N.A. (physician name not available), Tanaka Hiroshi , Tsuchiya Atsushi , Sakata Katsumi , Murata Hidetoshi , Nomura Motohiro , Ozawa Hitoshi , Tsumura Kotaro , Inaba Makoto , Mori Taturou , Terada Tomoaki , Mori Takahisa , Sugitani Masato , Tanaka Yuichiro , Yamada Masaru , Matsumae Mitsunori , Onitsuka Keiichirou , Miyahara Kosuke , Endou Sumio , Kojima Atsuhiro , Yagi Shinichi , Takahashi Hidekazu , Kaidu Hiroyuki , Tsunoda Akira , Nomura Kyoichi , Fujimaki Takamitsu , Ooigawa Hidetoshi , Tanaka Masahiko , Wanihuchi Hiroshi , Wada Hirochiyo , Hyodo Akio , Asakura Ken , Kazunori Akazi , Kurihara Hideyuki , Ohmori Shigehiro , Kusunoki Hiroshi , Magarisawa Satoshi ,   N.A. (physician name not available), Okabe Shinichi , Yamamoto Shinji , Oyama Hiroko , Tsuruoka Shin , Takeshita Mikihiko , Matsumura Akira , Uemura Kazuya , Tabata Hitoshi , Fujita Keishi ,   N.A. (physician name not available), Nakatsukasa Masashi , Shimoeda Norifumi , Kunimine Hideo , Ishihara Masayuki , Kikuchi Kazuhiro , Murai Nozomu , Taki Warou , Murakami Nobukuni , Kidooka Minoru , Iwamoto Yoshihiro , Tenjin Hiroshi , Shiga Kouji , Mori Nobuhito , Kohmura Eiji , Kondoh Takeshi , Yamashita Haruo , Matsumoto Keigo , Takeda Naoya , Sakaki Takayuki , Miyake Hiroji , Mabuchi Eiichiro , Yokota Masayuki , No  , Ohnishi Hideyuki ,   N.A. (physician name not available),   N.A. (physician name not available), Saiki Masaaki , Asahi Minoru , Koyama Junji , Sakagami Yoshio , Noda Shinya , Iida Junichi , Morimoto Tetsuya , Nakase Hiroyuki ,   N.A. (physician name not available), Hirabayashi Hidehiro , Nakao Naoyuki , Kuwata Toshikazu , Nakamura Yoshinari , Ishiguchi Hiroshi , Habu Teruyuki , Kurosaki Masamichi , Ohkuma Hiroki , Hasegawa Seiko , Konno Hiromu , Takemura Atsuhito , Okubo Atsuya , Saito Hitoshi , Moroi Junta , Shimizu Hiroaki , Sasou Masayuki , Watanabe Yoichi , Saito Kiyoshi , Satoh Masahiro , Watanabe Zenichiro , Koizumi Takayuki , Mashiyama Shoji , Oikawa Tomoyoshi , Yukihiko Sonoda , Kondo Rei , Shinoda Atsuo , Kamatsuka Eiichiro , So Keiten , Kinjo Toshihiko , Itou Kennji , Kudoh Yohei , Sato Kazuhiko , Hiroaki Arai , Endo Hidenori , Karibe Hiroshi , Takahashi Kou , Nakajima Masayuki , Watanabe Kazuyoshi , Nozaki Kazuhiko , Takayama Motohiro , Komuro Tarou , Suzuki Fumio ,   N.A. (physician name not available), Suzuki Hidenori , Murata Hiroto , Miya Fumitaka , Fukazawa Seiji , Takehara Seiya , Watanabe Yoshihiko , Nakayama Teiji , Sato Haruhiko , Amano Shinji , Kuroda Katsuhiro , Morooka Akira , Wataya Takafumi , Tanigawara Tetsuya , Iwama Toru , Ito Junki , Noda Shinji , Kouno Kazuyuki , Kitazawa Kazuo , Kusano Yoshikazu , Hokama Masanobu , Sato Hiroki , Kobayashi Sumio , Muraoka Shinsuke , Miyatake Masaki , Hayashida Kensuke , Sakai Keiichi , Ikawa Fusao , Ishida Gen , Kagawa Takato , Namba Youichirou , Nakashima Hiroyuki , Tokunaga Koji , Date Isao , Uno Masaaki , Chin Masaki , Sasayama Hidemichi , Yoshida Hideyuki ,   N.A. (physician name not available), Watanabe Akira , Harada Kunihiko , Urakawa Manabu , Hamada Yasuhiro , Suzuki Michiyasu , Nishizaki Takafumi , Yamashita Katsuhiro , Nakamura Ryuji , Sumida Masayuki , Wakabayashi Shinichi , Kurisu Kaoru , Tominaga Atsushi , Shibukawa Masaaki , Yukihiko Kawamoto , Okita Shinji , Hujiwara Kenjirou , Matsuoka Takashi , Hamasaki Osamu , Satomi Junichiro , Agawa Masahito , Oka Hirofumi , Yoshimura Kunikazu , Haga Sei , Asaoka Katsuyuki , Nakamura Toshitaka , Takeda Makoto , Kobayasi Nobuaki , Ushikoshi Satoshi , Mikuni Nobuhiro , Niwa Jun , Tanikawa Rokuya , Yamamura Akinori , Takahashi Akira , Watabe Noriaki , Sasaki Junkoh , Otawara Yasunari , Miura Kazuyuki , Tominaga Teiji , Sasaki Tatsuya , Sugawara Takayuki , Ezura Masayuki , Yamamoto Kenji , Ishikawa Syuichi , Masahiro Yoshida , Takemura Sunao , Kawakami Masahisa , Ihara Satoshi , Shibata Yasushi , Saegusa Takashi , Iuchi Toshihiko , Ito Chiaki , Hoshi Seiichiro , Isimaru Sumio , Okuda Osamu , Yoshida Kazunari , Akiyama Takekazu , Katayama Masateru , Kasai Masahiko , Kobayashi Tomonori , Akihiro Oikawa , Miura Naohisa , Tao Osamu , Oota Takahiro , Takenobu Atumi , Kumabe Toshihiro , Suzuki Sachio , Kumagai Takashi , Nishimaki Keiichi , Hongo Kazuhiro , Toba Yasuyuki , Takayuki Kuroyanagi , Shigeta Hiroaki , Sato Atsushi , Kuroda Satoshi , Park Cheho , Higashi Sotaro , Oyama Hirofumi , Hattori Kazuyoshi , Uozumi Yoichi , Nakahara Norimoto , Mase Mitsuhito , Hashimoto Nobukazu , Ichihashi Toshikazu , Takenaka Katsunobu , Shirakami Shinichi , Okumura Yoshinari , Yokoyama Kazuhiro , Miyamoto Susumu , Akiyama Yoshinori , Hashimoto Kenji , Saiki Masaaki , Yamamoto Kazuo , Isono Naofumi , Ichioka Tsugumichi , Kazutomo Nakazawa , Nishikawa Misao , Inoue Tsuyoshi , Kinoshita Manabu ,   N.A. (physician name not available), Yoshimura Shinichi , Saitoh Minoru , Aihara Hideo , Miyake Hajimu , Kuwayama Kazuyuki , Ogihara Kotaro , Nishino Shigeki , Miyoshi Yasuyuki , Arisawa Tadashi , Daido Shigeru , Kinoshita Kimihisa , Migita Keisuke , Akatsuka Keiichi , Fujisawa Hirosuke , Yamamoto Junkoh , Kinosita Yosimasa , Inoha Satoshi , Takaba Hitonori , Shono Tadahisa , Tsugu Hitoshi , Hayashi Shuji , Abe Tatsuya , Nakashima Susumu , Tuji Takehisa , Yamamoto Keizou , Kaga Akihiko , Kanemaru Reizou , Takasaki Koji , Imamura Junichi , Noha Masahiro , Watanabe Saburo , Sakai Nobuyuki , Minami Hiroaki , Okumura Tomoyoshi , Nishimura Shinjitsu , Numazawa Shinichi , Niimi Yasunari , Kitahara Isao , Nakagawa Hidemitu , Kazekawa Kiyoshi , Fukuyama Kouzou , Ichinose Makoto , Matuoka Koji , Fujimoto Yasuhiro , Hashimoto Youichi , Matsuoka Takeshi , Uchizawa Takamitsu , Satou Tomohiko , Hasebe Makoto , Kameda Tomoaki , Sawaura Hiroaki , Kubodera Takayuki , Utsuki Satoshi , Awamori Kazuaki , Takahashi Chiaki , Yamatani Kazumasa , Tsukada Toshiyuki , Hayashi Ryoichi , Kitahara Masakazu , Kakizawa Yukinari , Yamamoto Yasumasa , Yoshida Takashi , Okumura Shinji , Gotou Yasunobu , Tominaga Takashi , Hamaguchi Hirotoshi , Mori Nozomi , Shinohara Naoki , Ejima Yasushi , Mori Mayumi , Miyake Hitoshi , Idei Masaru , Nishiura Yoshihiro , Koga Hiromichi , Morimoto Kazuya , Son Jae-Hyun , Niiya Yoshimasa , Shishido Tsuneo , Murakami Mamoru , Yoshida Takaaki , Hara Masahito , Nakamura Tatsuya , Kawai Takuya , Inoue Takashi , Sasaki Isao , Hayashi Katsuhiko , Fujishima Ichiro , Fujimura Naoko , Kataoka Seiko , Yokota Masayuki 
Published: February 2022

To determine whether increasing thrombectomy-capable hospitals with moderate comprehensive stroke center (CSC) capabilities is a valid alternative to centralization of those with high CSC capabilities. This retrospective, nationwide, observational study used data from the J-ASPECT database linked to national emergency medical service (EMS) records, captured during 2013–2016. We compared the influence of mechanical thrombectomy (MT) use, the CSC score, and the total EMS response time on the modified Rankin Scale score at discharge among patients with acute ischemic stroke transported by ambulance, in phases I (2013–2014, 1461 patients) and II (2015–2016, 3259 patients). We used ordinal logistic regression analyses to analyze outcomes. From phase I to II, MTs increased from 2.7 to 5.5%, and full-time endovascular physicians per hospital decreased. The CSC score and EMS response time remained unchanged. In phase I, higher CSC scores were associated with better outcomes (1-point increase, odds ratio [95% confidence interval]: 0.951 [0.915–0.989]) and longer EMS response time was associated with worse outcomes (1-min increase, 1.007 [1.001–1.013]). In phase II, neither influenced the outcomes. During the transitional shortage of thrombectomy-capable hospitals, increasing hospitals with moderate CSC scores may increase nationwide access to MT, improving outcomes.