Interhospital Transfer for Endovascular Stroke Treatment in Canada: Results From the OPTIMISE Registry-Reference-Cited by-同舟云学术

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

Published:2024-08 Issue:8 Volume:55 Page:2103-2112
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Katsanos Aristeidis H.¹^ORCID,Poppe Alexandre²^ORCID,Swartz Rick H.³^ORCID,Mandzia Jennifer⁴^ORCID,Catanese Luciana^ORCID,Shankar Jai⁵^ORCID,Yip Samuel⁶,Verreault Steve⁷^ORCID,Medvedev George⁸^ORCID,Maran Ilavarasy⁹,Legault Catherine¹⁰,Ferguson Darren¹¹,Archer Brian¹¹,Bharatha Aditya¹²^ORCID,Volders David¹³^ORCID,Kelly Michael¹⁴^ORCID,Carpani Federico¹⁵^ORCID,Pikula Aleksandra¹⁵^ORCID,Tkach Alexander¹⁶^ORCID,Moreau Francois¹⁷,Beaudry Michel¹⁸,Appireddy Ramana¹⁹^ORCID,Deshmukh Aviraj²⁰^ORCID,Almekhlafi Mohammed²¹^ORCID,Fahed Robert²²^ORCID,Kamal Noreen²³^ORCID,Menon Bijoy²¹^ORCID,Shoamanesh Ashkan¹^ORCID,Williams Heather²⁴,Yu Amy Y.X.³^ORCID,Heran Manraj K.S.²⁵,Hill Michael D.²¹,Sharma Mukul¹^ORCID,Earl Karen²⁶,Demchuk Andrew M.²¹^ORCID,Stotts Grant²²^ORCID

Affiliation:

1. Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada (A.H.K., L.C., A.S., M.S.).

2. Department of Neurosciences, Université de Montréal and Centre Hospitalier de l’Université de Montréal, QC, Canada (A. Poppe).

3. Division of Neurology, Department of Medicine, Hurvitz Brain Sciences Program, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada (R.H.S., A.Y.X.Y.).

4. Department of Clinical Neurological Sciences, London Health Sciences Centre and Western University, ON, Canada (J.M.).

5. Department of Radiology, University of Manitoba, Winnipeg, Canada (J.S.).

6. Division of Neurology (S.Y.), The University of British Columbia, Vancouver, Canada.

7. CHU de Québec, Hôpital de l’Enfant-Jésus, Montreal, Canada (S.V.).

8. University of British Columbia and the Fraser Health Authority, New Westminster, Canada (G.M.).

9. Department of Neurology, Trillium Health Partners, Missisauga, ON, Canada (I.M.).

10. Division of Neurology, McGill University Health Centre, Montreal, QC, Canada (C.L.).

11. Department of Diagnostic Radiology, Dalhousie University, Saint John, NB, Canada (D.F., B.A.).

12. Department of Medical Imaging, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, ON, Canada (A.B.).

13. Diagnostic Imaging, Dalhousie University, Halifax, NS, Canada (D.V.).

14. Department of Neurosurgery, University of Saskatchewan, Saskatoon, Canada (M.K.).

15. Toronto Western Hospital and the University of Toronto, ON, Canada (F.C., A. Pikula).

16. Kelowna General Hospital, BC, Canada (A.T.).

17. Université de Sherbrooke, QC, Canada (F.M.).

18. Centre de santé et de services sociaux de Chicoutimi, Saguenay, QC, Canada (M.B.).

19. Division of Neurology, Department of Medicine, Queen’s University, Kingston, ON, Canada (R.A.).

20. Division of Clinical Sciences, Health Sciences North, Northern Ontario School of Medicine, Sudbury, ON, Canada (A.D.).

21. Department of Clinical Neurosciences, University of Calgary, AB, Canada (M.A., B.M., M.D.H., A.M.D.).

22. Division of Neurology, Department of Medicine, The Ottawa Hospital, ON, Canada (R.F., G.S.).

23. Department of Industrial Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada (N.K.).

24. Queen Elizabeth Hospital, Charlottetown, PE, Canada (H.W.).

25. Department of Radiology (M.K.S.H.), The University of British Columbia, Vancouver, Canada.

26. Canadian Stroke Consortium, Oakville, ON (K.E.).

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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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