Outcome and periprocedural time management in referred versus directly admitted stroke patients treated with thrombectomy

• Published in: Therapeutic advances in neurological disorders Vol. 9; no. 2; pp. 79 - 84
• Main Authors: Weber, Ralph, Reimann, Gernot, Weimar, Christian, Winkler, Angela, Berger, Klaus, Nordmeyer, Hannes, Hadisurya, Jeffrie, Brassel, Friedhelm, Kitzrow, Martin, Krogias, Christos, Weber, Werner, Busch, Elmar W., Eyding, Jens
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.03.2016; SAGE PUBLICATIONS, INC
• Subjects: Cerebral blood flow; Hospitals; Ischemia; Mortality; Neuroimaging; Original Research; Patients; Stroke; mortality; periprocedural times; functional outcome; referral status; thrombectomy; ischemic stroke
• ISSN: 1756-2864; 1756-2856; 1756-2864
• DOI: 10.1177/1756285615617081

Background: After thrombectomy has shown to be effective in acute stroke patients with large vessel occlusion, the potential benefit of secondary referral for such an intervention needs to be validated. Aims: We aimed to compare consecutive stoke patients directly admitted and treated with thrombectomy at a neurointerventional centre with patients secondarily referred for such a procedure from hospitals with a stroke unit. Methods: Periprocedure times and mortality in 300 patients primarily treated in eight neurointerventional centres were compared with 343 patients referred from nine other hospitals in a prospective multicentre study of a German neurovascular network. Data on functional outcome at 3 months was available in 430 (76.4%) patients. Results: In-hospital mortality (14.8% versus 11.7%, p = 0.26) and 3 months mortality (21.9% versus 24.1%, p = 0.53) were not statistically different in both patient groups despite a significant shorter symptom to groin puncture time in directly admitted patients, which was mainly caused by a longer interfacility transfer time. We found a nonsignificant trend for better functional outcome at 3 months in directly admitted patients (modified Rankin Scale 0–2, 44.0% versus 35.7%, p = 0.08). Conclusions: Our results show that a drip-and-ship thrombectomy concept can be effectively organized in a metropolitan stroke network. Every effort should be made to speed up the emergency interfacility transfer to a neurointerventional centre in stroke patients eligible for thrombectomy after initial brain imaging.