Outcomes of endovascular thrombectomy in acute ischemic stroke patients air-transferred from Kinmen to mainland Taiwan.

Abstract

Background: Since 2018, Taipei Veterans General Hospital (TVGH) has performed endovascular thrombectomy (EVT) on acute ischemic stroke patients air-transferred from Kinmen Hospital (KMH). This study evaluated the clinical profiles and outcomes of these patients, comparing them to those treated directly at TVGH.

Methods: In this retrospective study, we included consecutive acute ischemic stroke patients air-transferred from KMH to TVGH for EVT between January 2018 and April 2024. A comparison group comprised patients who presented directly to TVGH and underwent EVT during the same period. Transfer decisions at KMH were based on clinical presentation and neuroimaging evidence of large vessel occlusion. Only patients with salvageable brain tissue (substantial penumbra without a large infarct core) were transferred. Exclusion criteria included a premorbid modified Rankin Scale (mRS) score ≥3, in-hospital stroke, serious advanced illness, or life expectancy <6 months. Primary outcomes were 90-day functional independence (mRS 0-2), 30-day mortality, and symptomatic intracerebral hemorrhage (sICH). Analyses included Mann-Whitney, chi-square tests, and multivariate logistic regression.

Results: A total of 275 patients were included: 15 from KMH (mean age 71.1 ± 11.7 years; 40% male; median NIHSS 15) and 260 from TVGH (mean age 73.5 ± 13.6 years; 53% male; median NIHSS 18). KMH patients had longer onset-to-door times [median (IQR) 452.0 (400.0) vs. 217.0 (442.8) minutes; p < 0.001] but shorter door-to-puncture times [121.5 (43.5) vs. 144.0 (55.3) minutes; p = 0.031]. Among KMH patients, the substantial reperfusion rate was 73.3%, 90-day functional independence was 40.0%, sICH rate was 13.3%, and 30-day mortality was 13.3%, outcomes comparable to those of TVGH patients.

Conclusion: Despite longer transfer times, air-transferred patients achieved similar safety and efficacy outcomes after EVT compared to directly treated patients. Further studies are warranted to optimize transfer strategies and patient selection.