Objective:

To study the impact of direct transfer to a Thrombectomy Capable Center (TC) vs transfer to a Primary Stroke Center (PSC) on Acute Ischemic Stroke (AIS) Treatment times among non-urban patients with Large Vessel occlusion (LVO) undergoing Mechanical Thrombectomy (MT) in our healthcare system.

Background:

Our statewide Emergency Medical Services (EMS) protocols recommend that patients with a suspicion of an LVO may bypass the closest Stroke center to be transferred to a TC if it can be reached within 45 minutes.

Design/Methods:

This is a retrospective analysis of a prospectively maintained database of AIS patients between January 2021 and October 2023. We included consecutive patients with LVO who presented with pre-arrival notifications via EMS either directly to one of our two TC or were transferred from one of 11 PSC within our telestroke network to a TC and underwent MT. Patients who presented directly to TC and were within 30 minutes of driving distance were excluded. This cohort was divided into two groups: patients presenting directly to TC (DTC) and those initially transported to closest Stroke center (DSC). Primary outcomes were First Medical contact to Arterial Puncture time (FMC-to-AP) and First Medical Contact to Intravenous thrombolysis time (FMC-to-IVT). The Mann-Whitney U test was used to assess significant differences in continuous variables between the two groups.

Results:

Among 225 patients analyzed, 111(49.3%) were DTC. Median age was 72 years [IQR 62.0 - 81.0], median baseline NIHSS was 17 [IQR 12.0 - 22.0]. DTC patients had shorter FMC-to-AP (118min [IQR 106–138] vs. 200min [166–274], p<0.001), and similar FMC-to-IVT (83.0min [69–89.8] vs 87min [75–115], p=0.09).

Conclusions:

Among non-urban patients with LVO, direct transport to TC was associated with shorter FMC-to-AP without impacting FMC-to-IVT. Further research should focus on investigating the impact of these transport strategies on AIS treatment times across healthcare systems.