TY - JOUR
T1 - Interhospital transfer vs. direct presentation of patients with a large vessel occlusion not eligible for IV thrombolysis
AU - van Meenen, Laura C. C.
AU - Groot, Adrien E.
AU - Venema, Esmee
AU - Emmer, Bart J.
AU - Smeekes, Martin D.
AU - Kommer, Geert Jan
AU - Majoie, Charles B. L. M.
AU - Roos, Yvo B. W. E. M.
AU - Schonewille, Wouter J.
AU - Roozenbeek, Bob
AU - Coutinho, Jonathan M.
AU - van Zwam, Wim
AU - van Oostenbrugge, Robert Jan
AU - MR CLEAN Registry Investigators
PY - 2020/7
Y1 - 2020/7
N2 - Background and purpose Direct presentation of patients with acute ischemic stroke to a comprehensive stroke center (CSC) reduces time to endovascular treatment (EVT), but may increase time to treatment for intravenous thrombolysis (IVT). This dilemma, however, is not applicable to patients who have a contraindication for IVT. We examined the effect of direct presentation to a CSC on outcomes after EVT in patients not eligible for IVT. Methods We used data from the MR CLEAN Registry (2014-2017). We included patients who were not treated with IVT and compared patients directly presented to a CSC to patients transferred from a primary stroke center. Outcomes included treatment times and 90-day modified Rankin Scale scores (mRS) adjusted for potential confounders. Results Of the 3637 patients, 680 (19%) did not receive IVT and were included in the analyses. Of these, 389 (57%) were directly presented to a CSC. The most common contraindications for IVT were anticoagulation use (49%) and presentation > 4.5 h after onset (26%). Directly presented patients had lower baseline NIHSS scores (median 16 vs. 17, p = 0.015), higher onset-to-first-door times (median 105 vs. 66 min, p <0.001), lower first-door-to-groin times (median 93 vs. 150 min; adjusted beta = - 51.6, 95% CI: - 64.0 to - 39.2) and lower onset-to-groin times (median 220 vs. 230 min; adjusted beta = - 44.0, 95% CI: - 65.5 to - 22.4). The 90-day mRS score did not differ between groups (adjusted OR: 1.23, 95% CI: 0.73-2.08). Conclusions In patients who were not eligible for IVT, treatment times for EVT were better for patients directly presented to a CSC, but without a statistically significant effect on clinical outcome.
AB - Background and purpose Direct presentation of patients with acute ischemic stroke to a comprehensive stroke center (CSC) reduces time to endovascular treatment (EVT), but may increase time to treatment for intravenous thrombolysis (IVT). This dilemma, however, is not applicable to patients who have a contraindication for IVT. We examined the effect of direct presentation to a CSC on outcomes after EVT in patients not eligible for IVT. Methods We used data from the MR CLEAN Registry (2014-2017). We included patients who were not treated with IVT and compared patients directly presented to a CSC to patients transferred from a primary stroke center. Outcomes included treatment times and 90-day modified Rankin Scale scores (mRS) adjusted for potential confounders. Results Of the 3637 patients, 680 (19%) did not receive IVT and were included in the analyses. Of these, 389 (57%) were directly presented to a CSC. The most common contraindications for IVT were anticoagulation use (49%) and presentation > 4.5 h after onset (26%). Directly presented patients had lower baseline NIHSS scores (median 16 vs. 17, p = 0.015), higher onset-to-first-door times (median 105 vs. 66 min, p <0.001), lower first-door-to-groin times (median 93 vs. 150 min; adjusted beta = - 51.6, 95% CI: - 64.0 to - 39.2) and lower onset-to-groin times (median 220 vs. 230 min; adjusted beta = - 44.0, 95% CI: - 65.5 to - 22.4). The 90-day mRS score did not differ between groups (adjusted OR: 1.23, 95% CI: 0.73-2.08). Conclusions In patients who were not eligible for IVT, treatment times for EVT were better for patients directly presented to a CSC, but without a statistically significant effect on clinical outcome.
KW - Patient transfer
KW - Thrombectomy
KW - Thrombolysis
KW - Stroke
KW - ACUTE ISCHEMIC-STROKE
KW - ENDOVASCULAR THROMBECTOMY
KW - REPERFUSION
KW - TIME
KW - CARE
KW - CIRCULATION
KW - ACCESS
U2 - 10.1007/s00415-020-09812-5
DO - 10.1007/s00415-020-09812-5
M3 - Article
C2 - 32266543
VL - 267
SP - 2142
EP - 2150
JO - Journal of Neurology
JF - Journal of Neurology
SN - 0340-5354
IS - 7
ER -