Interhospital Transfer for Endovascular Stroke Treatment in Canada: Results From the OPTIMISE Registry.

IF 7.8 1区医学 Q1 CLINICAL NEUROLOGY

Stroke Pub Date : 2024-08-01 Epub Date: 2024-07-22 DOI:10.1161/STROKEAHA.124.046690

Aristeidis H Katsanos, Alexandre Poppe, Rick H Swartz, Jennifer Mandzia, Luciana Catanese, Jai Shankar, Samuel Yip, Steve Verreault, George Medvedev, Ilavarasy Maran, Catherine Legault, Darren Ferguson, Brian Archer, Aditya Bharatha, David Volders, Michael Kelly, Federico Carpani, Aleksandra Pikula, Alexander Tkach, Francois Moreau, Michel Beaudry, Ramana Appireddy, Aviraj Deshmukh, Mohammed Almekhlafi, Robert Fahed, Noreen Kamal, Bijoy Menon, Ashkan Shoamanesh, Heather Williams, Amy Y X Yu, Manraj K S Heran, Michael D Hill, Mukul Sharma, Karen Earl, Andrew M Demchuk, Grant Stotts

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引用次数: 0

Abstract

Background: Interhospital transfer for patients with stroke due to large vessel occlusion for endovascular thrombectomy (EVT) has been associated with treatment delays.

Methods: We analyzed data from Optimizing Patient Treatment in Major Ischemic Stroke With EVT, a quality improvement registry to support EVT implementation in Canada. We assessed for unadjusted differences in baseline characteristics, time metrics, and procedural outcomes between patients with large vessel occlusion transferred for EVT and those directly admitted to an EVT-capable center.

Results: Between January 1, 2018, and December 31, 2021, a total of 6803 patients received EVT at 20 participating centers (median age, 73 years; 50% women; and 50% treated with intravenous thrombolysis). Patients transferred for EVT (n=3376) had lower rates of M2 occlusion (22% versus 27%) and higher rates of basilar occlusion (9% versus 5%) compared with those patients presenting directly at an EVT-capable center (n=3373). Door-to-needle times were shorter in patients receiving intravenous thrombolysis before transfer compared with those presenting directly to an EVT center (32 versus 36 minutes). Patients transferred for EVT had shorter door-to-arterial access times (37 versus 87 minutes) but longer last seen normal-to-arterial access times (322 versus 181 minutes) compared with those presenting directly to an EVT-capable center. No differences in arterial access-to-reperfusion times, successful reperfusion rates (85% versus 86%), or adverse periprocedural events were found between the 2 groups. Patients transferred to EVT centers had a similar likelihood for good functional outcome (modified Rankin Scale score, 0-2; 41% versus 43%; risk ratio, 0.95 [95% CI, 0.88-1.01]; adjusted risk ratio, 0.98 [95% CI, 0.91-1.05]) and a higher risk for all-cause mortality at 90 days (29% versus 25%; risk ratio, 1.15 [95% CI, 1.05-1.27]; adjusted risk ratio, 1.14 [95% CI, 1.03-1.28]) compared with patients presenting directly to an EVT center.

Conclusions: Patients transferred for EVT experience significant delays from the time they were last seen normal to the initiation of EVT.

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加拿大脑卒中血管内治疗的院际转运：OPTIMISE 登记的结果。

背景：因大血管闭塞导致脑卒中的患者在医院间转院接受血管内血栓切除术（EVT）治疗时会出现延误：大血管闭塞导致的卒中患者院间转运接受血管内血栓切除术（EVT）与治疗延迟有关：我们分析了 "通过 EVT 优化大面积缺血性脑卒中患者治疗 "的数据，这是一项质量改进登记，旨在支持 EVT 在加拿大的实施。我们评估了转院接受 EVT 的大血管闭塞患者与直接入住具备 EVT 能力的中心的患者在基线特征、时间指标和程序结果方面的未调整差异：2018年1月1日至2021年12月31日期间，共有6803名患者在20个参与中心接受了EVT治疗（中位年龄73岁；50%为女性；50%接受静脉溶栓治疗）。与直接到有 EVT 能力的中心就诊的患者（3376 人）相比，转院接受 EVT 的患者（3376 人）M2 闭塞率较低（22% 对 27%），基底动脉闭塞率较高（9% 对 5%）。与直接到EVT中心就诊的患者相比，转院前接受静脉溶栓治疗的患者从进门到进针的时间更短（32分钟对36分钟）。与直接前往具备EVT能力的中心就诊的患者相比，转院接受EVT治疗的患者从门诊到动脉通路的时间更短（37分钟对87分钟），但最后一次见到正常患者到动脉通路的时间更长（322分钟对181分钟）。两组患者的动脉通路到再灌注时间、再灌注成功率（85% 对 86%）或围手术期不良事件均无差异。转入EVT中心的患者获得良好功能预后的可能性相似（改良Rankin量表评分，0-2分；41%对43%；风险比，0.95 [95% CI，0.88-1.01]；调整后风险比，0.98 [95% CI，0.91-1.05]），但获得良好功能预后的风险较高。与直接到EVT中心就诊的患者相比，90天内全因死亡的风险更高（29%对25%；风险比为1.15 [95% CI, 1.05-1.27]；调整后风险比为1.14 [95% CI, 1.03-1.28]）：结论：转院接受EVT治疗的患者从最后一次正常就诊到开始接受EVT治疗会有明显的延迟。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Stroke 医学-临床神经学

CiteScore

13.40

自引率

6.00%

发文量

2021

审稿时长

3 months

期刊介绍： Stroke is a monthly publication that collates reports of clinical and basic investigation of any aspect of the cerebral circulation and its diseases. The publication covers a wide range of disciplines including anesthesiology, critical care medicine, epidemiology, internal medicine, neurology, neuro-ophthalmology, neuropathology, neuropsychology, neurosurgery, nuclear medicine, nursing, radiology, rehabilitation, speech pathology, vascular physiology, and vascular surgery. The audience of Stroke includes neurologists, basic scientists, cardiologists, vascular surgeons, internists, interventionalists, neurosurgeons, nurses, and physiatrists. Stroke is indexed in Biological Abstracts, BIOSIS, CAB Abstracts, Chemical Abstracts, CINAHL, Current Contents, Embase, MEDLINE, and Science Citation Index Expanded.

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