Background on Stroke and Mechanical Thrombectomy

Stroke remains one of the leading causes of death and long-term disability worldwide. Mechanical thrombectomy, often abbreviated as MT, is an endovascular procedure that physically removes blood clots from large arteries in the brain to restore blood flow in patients with large vessel occlusion stroke, known as LVOS. This intervention has transformed acute stroke care since landmark trials in 2015 demonstrated its effectiveness when combined with or instead of intravenous thrombolysis.

The procedure requires specialized centers equipped with interventional neuroradiology teams available around the clock. Expanding access through new centers addresses geographic disparities, particularly in regions far from comprehensive stroke centers, or CSCs.

The French Context for Thrombectomy-Capable Stroke Centers

In France, stroke care organization includes stroke units and MT centers. Prior to 2019, MT was largely restricted to CSCs for regulatory and training reasons. The Nouvelle-Aquitaine region had its primary CSC in Bordeaux, leaving southern areas around Bayonne and Pau, serving approximately one million residents, more than 200 kilometers away. This distance created significant delays in the drip-and-ship model, where patients are initially treated at a local hospital and then transferred for MT.

French regulations later authorized thrombectomy-capable stroke centers, or TSCs, in select non-university hospitals meeting criteria such as geographic need, infrastructure including a stroke unit and intensive care, and projected case volume exceeding 600 strokes annually. Bayonne Hospital opened its TSC in March 2019 after operators completed two years of training at the Bordeaux CSC.

The Research Publication and Its Authors

A study published in the October 2026 issue of the Journal of Clinical Neuroscience examines the effects of this new center. The paper, titled "Impact of a newly opened mechanical thrombectomy center on stroke management: volume, delays, and clinical outcomes," is available at https://www.sciencedirect.com/science/article/abs/pii/S0967586826003115. It was authored by Océane Trouille, Louis Veunac, Jérôme Berge, Thomas Tourdias, Gaultier Marnat, and Quentin Bourgeois-Beauvais.

The research team analyzed data from prospective stroke databases at Bayonne and Bordeaux hospitals, comparing the period before the TSC opening with the subsequent mothership model where patients receive on-site MT at Bayonne.

Study Design and Patient Population

Researchers conducted a retrospective analysis of patients with ischemic stroke and LVOS who presented to Bayonne. The drip-and-ship group included 82 patients transferred to Bordeaux for MT before March 2019. The mothership group comprised 190 patients treated on-site at Bayonne after the TSC opened. The overall cohort totaled 272 patients spanning March 2015 to February 2023.

Key metrics evaluated included annual MT volume, onset-to-puncture times, recanalization success measured by modified Thrombolysis in Cerebral Infarction scores (mTICI 2b-3 and mTICI 3), procedural complications, early neurological improvement via National Institutes of Health Stroke Scale (NIHSS) changes, and 90-day functional outcomes using the modified Rankin Scale (mRS).

Impact on Mechanical Thrombectomy Volume

One of the most striking results was the tripling of annual MT procedures in the first year after the TSC opened, rising from approximately 20 to 60 cases. This surge reflects increased utilization in a previously underserved territory, demonstrating how localized capacity directly expands treatment access without relying solely on transfers.

The increase aligns with broader trends in France, where national MT numbers grew substantially following expanded indications from trials covering longer time windows and additional occlusion sites. The Bayonne experience illustrates how TSCs can accelerate this growth locally.

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Reduction in Treatment Delays

Treatment timing proved markedly improved under the mothership model. Median onset-to-puncture time dropped from 335 minutes (interquartile range 280–375) in the drip-and-ship group to 198 minutes (interquartile range 158–248) in the mothership group, representing a statistically significant reduction of 137 minutes (p < 0.001).

Shorter delays are critical because each minute of ischemia leads to the loss of millions of neurons. The mothership approach eliminates transfer logistics, enabling faster intervention and potentially better preservation of brain tissue.

Clinical Outcomes, Safety, and Efficacy

Recanalization rates remained comparable between groups, with adjusted odds ratios showing no significant differences for successful reperfusion (mTICI 2b-3: aOR 0.82; mTICI 3: aOR 0.80). Procedural complications also showed no meaningful increase in the mothership cohort (aOR 2.15).

Patients in the mothership group experienced greater early neurological improvement, with an average NIHSS reduction of 3.02 points more than the drip-and-ship group (p = 0.011). While 90-day functional outcomes showed a positive trend favoring the mothership model, it did not reach statistical significance (p = 0.19). Safety profiles stayed consistent, supporting the viability of decentralized MT delivery.

Implications for Reducing Geographic Disparities in Stroke Care

The findings underscore the value of strategic TSC placement in areas distant from CSCs. By bringing advanced care closer to patients, such centers mitigate the inequities that arise from centralized models. The Bayonne case provides concrete evidence that expanded territorial coverage can boost volume, shorten critical time intervals, and enhance early recovery without compromising safety or efficacy.

This approach supports policy efforts to evaluate and implement additional TSCs where access times exceed 90 minutes to the nearest CSC, potentially improving population-level stroke outcomes across France and similar healthcare systems.

Challenges in Implementing New Thrombectomy Centers

Establishing a TSC requires substantial investment in infrastructure, 24/7 staffing by trained interventionalists, and ongoing quality monitoring. Training periods, such as the two years undertaken by Bayonne operators, highlight the human capital demands. Regulatory approvals based on volume projections and geographic criteria add further layers of planning.

Workflow optimization remains essential even after opening, as pre-hospital triage, imaging speed, and team coordination directly influence overall times. The study notes that while volume increased significantly, sustained high performance depends on continued adherence to best practices.

Future Outlook and Broader Applications

The success in Bayonne encourages further rollout of TSCs to address remaining gaps in access. As indications for MT continue to broaden based on recent trials, demand will likely rise, making decentralized capacity even more relevant. Ongoing evaluation of similar initiatives could refine criteria for new centers and identify optimal network configurations.

Integration with emerging technologies, such as advanced imaging for patient selection and telemedicine for consultation, may further enhance outcomes in mothership settings. The study authors conclude that expanded MT coverage merits continued assessment as a strategy to reduce disparities.

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Conclusion

The opening of the mechanical thrombectomy center at Bayonne Hospital delivered measurable gains in treatment volume, substantial reductions in delays, and improved early neurological recovery while maintaining safety and recanalization success. This real-world example from the French healthcare system offers valuable insights for stroke networks worldwide seeking to optimize access to time-sensitive endovascular care. The peer-reviewed analysis by Océane Trouille and colleagues provides a rigorous foundation for such expansions.