In this cross-sectional study data from 299 certified stroke units (SU) in Germany were analyzed from January 2016 to December 2018 and included comprehensive stroke centers (CSC 34%), local SU (62%), and telemedical SU (4%). In a total of 2487 SU monitor beds, 251,539 cases of stroke treatment were documented. The number of monitor beds (10.8 vs. 7.2) and stroke cases per year (1143 vs. 708) were significantly higher in CSC than in local SU. A total of 9251 endovascular recanalization (ER) procedures were performed annually by 475 interventionalists. The overall rate of ER was 3.7% of all stroke cases, including intracerebral hemorrhage (ICH) and transient ischemic attacks (TIA). A total of 124 of the SUs (41.5%) had a 24/7 ER structure in which 55% of all stroke treatments and 96% of all ERs were carried out. In the vast majority of CSC the ER structure was robust (≥4 interventionalists, 52%) or acceptable (3 interventionalists, 27%). In contrast, the majority of local SU (88%) had to transfer patients for ER over average distances of 40 km (range 1-160 km). Overall, the ER structures in Germany between 2016 and 2018 could be described as good to very good.
Keywords: Certification; Mechanical thrombectomy; Referral concept; Stroke; Transfer distance.