[en] [en] BACKGROUND AND PURPOSE: Patients with acute ischaemic stroke and a large vessel occlusion who present to a non-endovascular-capable centre often require inter-hospital transfer for thrombectomy. Whether the inter-hospital transfer time is associated with 3-month functional outcome is poorly known.
METHODS: Acute stroke patients enrolled between January 2015 and December 2022 in the prospective French multicentre Endovascular Treatment of Ischaemic Stroke registry were retrospectively analysed. Patients with an anterior circulation large vessel occlusion transferred from a non-endovascular to a comprehensive stroke centre for thrombectomy were eligible. Inter-hospital transfer time was defined as the time between imaging in the referring hospital and groin puncture for thrombectomy. The relationship between transfer time and favourable 3-month functional outcome (modified Rankin Scale 0-2) was assessed through a mixed logistic regression model adjusting for centre and symptom-onset-to-referring-hospital imaging time, age, sex, diabetes, referring hospital National Institutes of Health Stroke Scale score, Alberta Stroke Programme Early Computed Tomography Score, occlusion site and intravenous thrombolysis use.
RESULTS: Overall, 3769 patients were included (median inter-hospital transfer time 161 min, interquartile range 128-195; 46% with favourable outcome). A longer transfer time was independently associated with lower rates of favourable outcome (p < 0.001). Compared to patients with transfer time below 120 min, there was a 15% reduction in the odds of achieving favourable outcome for transfer times between 120 and 180 min (adjusted odds ratio 0.85; 95% confidence interval 0.67-1.07), and a 36% reduction for transfer times beyond 180 min (adjusted odds ratio 0.64; 95% confidence interval 0.50-0.81).
CONCLUSIONS: A shorter inter-hospital transfer time is strongly associated with favourable 3-month functional outcome. A speedier inter-hospital transfer is of critical importance to improve outcome.
Disciplines :
Neurology
Author, co-author :
Seners, Pierre ; Neurology Department, Rothschild Foundation Hospital, Paris, France ; Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR_S1266, INSERM, Université de Paris, Paris, France
Khyheng, Maeva; Biostatistics, Lille University Hospital, Lille, France
Labreuche, Julien; Biostatistics, Lille University Hospital, Lille, France
Lapergue, Bertrand; Neurology Department, Foch Hospital, Suresnes, France
Pico, Fernando; Neurology Department, Mignot Hospital, Versailles, France
ETIS investigators
Other collaborator :
Delvoye, François ; Université de Liège - ULiège > Département des sciences cliniques
Language :
English
Title :
Inter-hospital transfer for thrombectomy: transfer time is brain.
Seners P, Scheldeman L, Christensen S, et al. Determinants of infarct core growth during inter-hospital transfer for thrombectomy. Ann Neurol. 2023;93:1117-1129.
Guenego A, Mlynash M, Christensen S, et al. Hypoperfusion ratio predicts infarct growth during transfer for thrombectomy. Ann Neurol. 2018;84:616-620.
Boulouis G, Lauer A, Siddiqui AK, et al. Clinical imaging factors associated with infarct progression in patients with ischemic stroke during transfer for mechanical thrombectomy. JAMA Neurol. 2017;74:1361-1367.
Mulder M, Jansen IGH, Goldhoorn RB, et al. Time to endovascular treatment and outcome in acute ischemic stroke: MR CLEAN registry results. Circulation. 2018;138:232-240.
Saver JL, Goyal M, van der Lugt A, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016;316:1279-1288.
Seners P, Mlynash M, Sreekrishnan A, et al. Infarct core growth during interhospital transfer for thrombectomy is faster at night. Stroke. 2023;54:2167-2171.
McTaggart RA, Moldovan K, Oliver LA, et al. Door-in-door-out time at primary stroke centers may predict outcome for emergent large vessel occlusion patients. Stroke. 2018;49:2969-2974.
McTaggart RA, Yaghi S, Cutting SM, et al. Association of a primary stroke center protocol for suspected stroke by large-vessel occlusion with efficiency of care and patient outcomes. JAMA Neurol. 2017;74:793-800.
Marto JP, Borbinha C, Calado S, Viana-Baptista M. The stroke chronometer—a new strategy to reduce door-to-needle time. J Stroke Cerebrovasc Dis. 2016;25:2305-2307.
Fousse M, Grün D, Helwig SA, et al. Effects of a feedback-demanding stroke clock on acute stroke management: a randomized study. Stroke. 2020;51:2895-2900.
Wong JZW, Dewey HM, Campbell BCV, et al. Door-in-door-out times for patients with large vessel occlusion ischaemic stroke being transferred for endovascular thrombectomy: a Victorian state-wide study. BMJ Neurol Open. 2023;5:e000376.
Requena M, Olivé-Gadea M, Muchada M, et al. Direct to angiography suite without stopping for computed tomography imaging for patients with acute stroke: a randomized clinical trial. JAMA Neurol. 2021;78:1099-1107.
Hubert GJ, Hubert ND, Maegerlein C, et al. Association between use of a flying intervention team vs patient interhospital transfer and time to endovascular thrombectomy among patients with acute ischemic stroke in nonurban Germany. JAMA. 2022;327:1795-1805.
Morey JR, Oxley TJ, Wei D, et al. Mobile interventional stroke team model improves early outcomes in large vessel occlusion stroke: the NYC MIST trial. Stroke. 2020;51:3495-3503.
Baron JC. Protecting the ischaemic penumbra as an adjunct to thrombectomy for acute stroke. Nat Rev Neurol. 2018;14:325-337.
