Objective:

Background:

MT is the standard of care for patients with large vessel occlusion and salvageable tissue.  Whether the benefit of thrombectomy is maintained for patients transferred to a thrombectomy-capable center in a real-world setting remains unknown. 

Design/Methods:

We collected data for all patients who underwent MT at a single center between May 2016 and July 2021. Outcomes were compared between transferred and direct admit patients. Our outcomes measurements included National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) at 90 days. We used Mann-Whitney U and chi-square tests for univariate analysis. Multivariate regression analysis was also carried out to assess the relationship between transfer status and long-term functional independence (90 days mRS 0-2).

Results:

246/620 (40%) patients undergoing MT were transferred and 374/620 (60%) were direct admits. There was no difference in age (68 vs. 70 years, P=0.58), baseline NIHSS (16 vs. 15, P=0.20), or ASPECTs score (7 vs. 8, P=0.06). The duration from symptom-onset to groin was longer (393 vs. 270 min, P<0.01) and rate of IV thrombolysis was more (48.4% vs. 37.4%, P=0.007) in the transferred patients. Functional independence (mRS 0-2) at 90 days was observed in 44.6% of the patients in the transferred group compared to 49.2% in the direct admit group (P=0.928). On multivariate analysis, transfer status was not an independent predictor of long-term functional independence (ARR 1.976, 95% CI 0.807-4.838, P=0.136).

Conclusions:

No difference was found in functional independence between stroke patients who received mechanical thrombectomy following inter-hospital transfer compared to patients who present directly to a thrombectomy-capable center. These findings emphasize that optimizing tele-stroke workflow can mitigate the adverse effects of delay during transportation for patients that present to remote hospitals in rural areas.