To investigate the difference of endovascular treatment (EVT) in primary stroke center (PSC) and advanced stroke center (ASC) for patients with acute large-vessel occlusion stroke.

A retrospective analysis was conducted on the clinical data of 398 patients with acute large-vessel occlusion stroke who received EVT in Neurology Department of Xuyi County People's Hospital and Zhongda Hospital Southeast University from January 2020 to December 2024. Based on the level of stroke centers, all patients were divided into the ASC group (234 cases) and the PSC group (164 cases). The baseline characteristics, ways of endocascular treatment, perioperative complications, and functional outcomes were compared between the two groups.

Compared with PSC group, there were statistically significant differences in atrial fibrillation, diabetes, intravenous thrombolysis, time from onset to treatment, transferred from primary hospitals, time from puncture to recalculation, operation time and operation method (P<0.05). There was no significant difference in age, male, hypertension, hyperlipidemia, smoking history, stroke history, coronary heart disease, valvular heart disease, baseline NIHSS score, responsible vessels and TOAST classification, time of thrombectomy, successfull recalculation rate, symptomatic intracranial hemorrhage, death, and good prognosis at 90 d (P>0.05).

Compared with PSC, ASC received more patients transferred from primary hospitals, more patients received bridging therapy, and ASC had a higher proportion of thrombectomy combined with balloon angioplasty or stenting. ASC neurointerventionists can finish surgery in shorter time. There was no significant difference in surgical safety and efficacy of acute large-vessel occlusion stroke treated with EVT between the two centers.