Mechanical Recanalization after Transfer from a Distant Primary Stroke Center: Effectiveness and Future Directions

Introduction: Little is known about the effectiveness of endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) admitted to a primary stroke center (PSC). The aim of this study was to assess EVT effectiveness after transfer from a PSC to a dista...

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Published in:Journal of stroke and cerebrovascular diseases 2019-11, Vol.28 (11), p.104368-104368, Article 104368
Main Authors: Farouil, Geoffroy, Sablot, Denis, Leibinger, Franck, Van Damme, Laurène, Coll, Francis, Gaillard, Nicolas, Ibanez, Majo, Smadja, Philippe, Benayoun, Laurent, Dutray, Anais, Tardieu, Maxime, Nguyen Them, Ludovic, Bonnec, Jean-Marie, Jurici, Snejana, Bensalah, Zoubir Mourad, Olivier, Nadège, Desmond, Lucie, Fadat, Bénédicte, Bertrand, Jean Louis, Mas, Julie, Akouz, Aziz, Allou, Thibaut, Mourand, Isabelle, Ferraro-Allou, Adelaïde, Dumitrana, Adrian, Aptel, Sabine, Arquizan, Caroline, Costalat, Vincent, Bonafe, Alain
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Comprehensive Health Care
Disability Evaluation
Endovascular Procedures - adverse effects
Female
Health Services Accessibility
Humans
ischemic strokes
Male
Middle Aged
Prospective Studies
Recovery of Function
Regional Health Planning
Registries
reperfusion
Risk Factors
Stroke - diagnosis
Stroke - physiopathology
Stroke - therapy
stroke management
stroke unit
Thrombectomy
Time Factors
Time-to-Treatment
Transportation of Patients
Treatment Outcome
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Summary:Introduction: Little is known about the effectiveness of endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) due to large vessel occlusion (LVO) admitted to a primary stroke center (PSC). The aim of this study was to assess EVT effectiveness after transfer from a PSC to a distant (156 km apart; 1.5 hour by car) comprehensive stroke center (CSC), and to discuss perspectives to improve access to EVT, if indicated. Patients and Method: Analysis of the data collected in a 6-year prospective registry of patients admitted to a PSC for AIS due to LVO and selected for transfer to a distant CSC for EVT. The rate of transfer, futile transfer, EVT, reperfusion (thrombolysis in cerebral infarction score ≥2b-3), and relevant time measures were determined. Results: Among the 529 patients eligible, 278 (52.6%) were transferred and 153 received EVT (55% of transferred patients) followed by reperfusion in 115 (overall reperfusion rate: 21.7%). Median times (interquartile range) were: 90 minutes (76-110) for PSC-door-in to PSC-door-out, 88 minutes (65-104) for PSC-door-out to CSC-door-in, 262 minutes (239-316) for PSC-imaging to reperfusion, and 393 minutes (332-454) for symptom onset to reperfusion. At 3 months, rates of favorable outcome (modified Rankin Scale 0-2) were not significantly different between patients eligible for EVT (42.4%), transferred patients (49.1%) and patients who underwent EVT (34.1%). Discussion and Conclusions: Our study suggests that transfer to a distant CSC is associated with reduced access to early EVT. These results argue in favor of on-site EVT at high volume PSCs that are distant from the CSC.
ISSN:1052-3057
1532-8511
DOI:10.1016/j.jstrokecerebrovasdis.2019.104368