Physician Transfer Versus Patient Transfer for Mechanical Thrombectomy in Patients With Acute Ischemic Stroke: A Systematic Review and Meta‐Analysis

Author:

Qureshi Adnan I.12ORCID,Lodhi Abdullah1ORCID,Maqsood Hamza1ORCID,Ma Xiaoyu1ORCID,Hubert Gordian J.3ORCID,Gomez Camilo R.2ORCID,Kwok Chun S.4ORCID,Ford Daniel E.5ORCID,Hanley Daniel F.6ORCID,Mehr David R.7ORCID,Shah Qaisar A.8,Suri M. Fareed K.9ORCID

Affiliation:

1. Zeenat Qureshi Stroke Institutes St Cloud MN USA

2. Department of Neurology University of Missouri Columbia MO USA

3. Department of Neurology, TEMPiS Telestroke Center München Klinik gGmbH Munich Germany

4. Department of Cardiology, Queen Elizabeth Hospital Birmingham University Hospitals of Birmingham NHS Trust Stoke‐on‐Trent UK

5. Department of Medicine Johns Hopkins University Baltimore MD USA

6. Department of Neurology Johns Hopkins University Baltimore MD USA

7. Department of Geriatric Medicine University of Missouri Columbia MO USA

8. Department of Neurology Winchester Medical Center Winchester VA USA

9. Department of Neurology CentraCare St Cloud MN USA

Abstract

Background Physician transfer is an alternate option to patient transfer for expedient performance of mechanical thrombectomy in patients with acute ischemic stroke. Methods and Results We conducted a systematic review to identify studies that evaluate the effect of physician transfer in patients with acute ischemic stroke who undergo mechanical thrombectomy. A search of PubMed, Scopus, and Web of Science was undertaken, and data were extracted. A statistical pooling with random‐effects meta‐analysis was performed to examine the odds of reduced time interval between stroke onset and recanalization, functional independence, death, and angiographic recanalization. A total of 12 studies (11 nonrandomized observational studies and 1 nonrandomized controlled trial) were included, with a total of 1894 patients. Physician transfer was associated with a significantly shorter time interval between stroke onset and recanalization with a pooled mean difference estimate of −62.08 (95% CI, −112.56 to −11.61]; P =0.016; 8 studies involving 1419 patients) with high between‐study heterogeneity in the estimates ( I 2 =90.6%). The odds for functional independence at 90 days were significantly higher (odds ratio, 1.29 [95% CI, 1.00–1.66]; P =0.046; 7 studies with 1222 patients) with physician transfer with low between‐study heterogeneity ( I 2 =0%). Physician transfer was not associated with higher odds of near‐complete or complete angiographic recanalization (odds ratio, 1.18 [95% CI, 0.89–1.57; P =0.25; I 2 =2.8%; 11 studies with 1856 subjects). Conclusions Physician transfer was associated with a significant reduction in the mean of time interval between symptom onset and recanalization and increased odds for functional independence at 90 days with physician transfer compared with patient transfer among patients who undergo mechanical thrombectomy.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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