Elsa A Olson, Christina A Rogers, Manhal M Siddiqi, Jacob S Riccio, Bichun Ouyang, Sarah Song, R Webster Crowley, Michael Chen, Laurel J Cherian, Stephan A Munich
Despite longer LKW-to-arrival and LKW-to-puncture times, transferred AIS patients had similar clinical and radiographic outcomes following MT compared to those presenting directly to our center. These findings suggest that, within this cohort, the time needed for transfer to an experienced center was not associated with worse outcomes compared to direct presentation. Whether earlier treatment at a lower-volume center would have yielded comparable or superior outcomes cannot be determined from this study.
BACKGROUND AND OBJECTIVES: Timely medical and procedural intervention has been a tenet of the management of patients with acute ischemic stroke (AIS). Treatment at a comprehensive, high-volume center consistently has been associated with improved clinical outcomes. At times, these principles of management may be in conflict with each other when patients do not present directly to a comprehensive, experienced center.
METHODS: We retrospectively analyzed the data from 193 patients with AIS who underwent mechanical thrombectomy (MT) at a single center, academic comprehensive stroke center, comparing clinical and radiographic data for patients who were transferred (157 (81.3%)) to those who presented directly to our center (36 (18.7%)).
RESULTS: Patients who presented directly had shorter last known well (LKW)-to-arrival and LKW-to-puncture time compared to those who were transferred (median 1.83 hours vs 6.17 hours (p < 0.0001) and median 4.12 hours vs 6.67 hours (p = 0.001), respectively). Patients presenting directly and those who were transferred had similar change in NIHSS from initial NIHSS to discharge NIHSS (median -7.5 vs -7 (p = 54), respectively), similar discharge NIHSS (median 3.5 vs 5 (p = 0.24), respectively), similar rates of mRS 0-2 (38.9% vs 31.2% (p = 0.38), respectively) and similar rates of TICI 2b-3 (86.1% vs 88.4% (p = 0.78), respectively).
CONCLUSIONS: Despite longer LKW-to-arrival and LKW-to-puncture times, transferred AIS patients had similar clinical and radiographic outcomes following MT compared to those presenting directly to our center. These findings suggest that, within this cohort, the time needed for transfer to an experienced center was not associated with worse outcomes compared to direct presentation. Whether earlier treatment at a lower-volume center would have yielded comparable or superior outcomes cannot be determined from this study.