The optimal structure of the acute ischaemic stroke treatment network is unknown and eagerly sought. To make it most effective, different treatment and transportation strategies have been developed and investigated worldwide. Since only a fraction of acute stroke patients with large vessel occlusion are treated, a new entity—thrombectomy-capable stroke centre (TCSC)—was introduced to respond to the growing demand for timely endovascular treatment. The purpose of this study was to present the early experience of the first 70 patients treated by mechanical means in a newly developed cardiac Cathlab-based TCSC. The essential safety and efficacy measures were recorded and compared with those reported in the invasive arm of the HERMES meta-analysis—the largest published dataset on the subject. We found no significant differences in terms of clinical and safety outcomes, such as early neurological recovery, level of functional independence at 90 days, symptomatic intracranial haemorrhage, parenchymal haematoma type 2, and mortality. These encouraging results obtained in the small endovascular centre may be an argument for the introduction of the TCSC into operating stroke networks to increase patient access to timely treatment and to improve clinical outcomes.

(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.

Introduction. Tandem lesions, where extracranial and intracranial vascular pathology coexists, have a poor prognosis and are a significant cause of acute ischemic stroke (AIS) with large vessel occlusion (LVO); they present unique challenges in diagnosis and endovascular treatment. Aim of the study. This retrospective study analyzed demographic parameters, risk factors, qualification procedures, fibrinolytic therapy, interventional management, complications, technical aspects, and clinical outcomes in tandem-occlusion anterior circulation stroke (TOS) patients treated at a Thrombectomy Capable Stroke Center (TCSC) in Wejherowo from 2020 to 2024. Acute stroke patients with TOS were compared to two groups: patients with isolated intracranial artery occlusion (iLVO) and patients with isolated extracranial internal carotid artery (iICA) lesion. Material and methods. A total number of 193 patients who underwent endovascular therapy (EVT) were involved. The comparison between selected populations was performed to analyze frequency, risk factors, procedure complexity, complications, and clinical outcome. Results. In the observed group the prevalence of tandem lesions was 17.1%, isolated extracranial internal carotid artery (ICA) occlusion was 11.4%, and isolated intracranial artery occlusion—71.5%. Tandem and ICA occlusion patients were younger (66.21 ± ± 9.8 vs. 70.34 ± 12.16; p < 0.01) and had a higher prevalence of smoking (45% vs. 26.1%; p < 0.05) compared to the intracranial LVO group. The latter had a higher rate of atrial fibrillation (21.2% vs. 60.9%; p < 0.001). Time intervals, including onset-to- -reperfusion (301.66 vs. 246.15 minutes; p < 0.01) and related to it: groin-to-first pass, groin-to-recanalization were significantly prolonged in the tandem group. Clinical outcomes, as measured by the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS), were worse in the tandem group compared to both the intracranial LVO (mRS 0–2: 24.2% vs. 44.9%; p < 0,01; NIHSS: 9.96 vs. 7.01; p < 0.01) and isolated extracranial ICA occlusion groups (mRS 0–2: 24.2% vs. 59.1%; p < 001; NIHSS: 9.96 vs. 4.53; p < 0.01). There were no significant differences in complication rates between the groups. Conclusions and clinical implications. In the analyzed cohort of interventionally treated AIS patients, the presence of tandem lesions was correlated with poor clinical outcomes and associated with the presence of atherosclerosis risk factors. Endovascular procedures in these cases were more complex and involved extended time intervals. Conversely, patients with isolated intracranial lesions were generally older, with atrial fibrillation being the primary risk factor. In these patients, endovascular procedure times were shorter and resulted in more favorable clinical outcomes. Keywords: tandem lesions acute ischemic stroke mechanical thrombectomy carotid artery stenting carotid artery occlusion