Interhospital transfer vs. direct presentation of patients with a large vessel occlusion not eligible for IV thrombolysis

Meenen, L.C.C. van; Groot, A.E.; Venema, E.; Emmer, B.J.; Smeekes, M.D.; Kommer, G.J.; ... ; MR CLEAN Registry Investigators (2020)

Article / Letter to editor

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.

• Patient transfer
• Thrombectomy
• Thrombolysis
• Stroke

• All authors: Meenen, L.C.C. van; Groot, A.E.; Venema, E.; Emmer, B.J.; Smeekes, M.D.; Kommer, G.J.; Majoie, C.B.L.M.; Roos, Y.B.W.E.M.; Schonewille, W.J.; Roozenbeek, B.; Coutinho, J.M.; MR CLEAN Registry Investigators
• Date: 2020-04-07
• Journal: Journal of Neurology
• Volume: 267
• Issue: 7
• Pages: 2142 - 2150
• DOI: doi:10.1007/s00415-020-09812-5
• Link: https://link.springer.com/article/10.1007/s00415-020-09812-5