Abstract W P6: Transfer for Intra-Arterial Stroke Treatment and its Impact on Clinical Outcome

Abstract

OBJECTIVE: Patients referred to stroke centers from community hospitals for intra-arterial stroke treatment (IAT) may experience significant delay during the transfer process. We sought to determine the difference in clinical outcomes amongst patients presenting directly to stroke centers (PD) versus those transferred from outside community hospitals (TR). METHODS: We reviewed records of patients who underwent IAT at our center from July 2012 – July 2014. All patients had intracranial large vessel occlusion and a baseline ASPECT score of ≥ 6. Patients demographics, risk factors, admission clinical and neuroimaging findings, treatment times and methods, procedure related complications and modified Rankin score (mRS) at 90 days were analyzed. For patients who are not yet at 90 days post-treatment, mRS at hospital discharge was used in the final analysis. A favorable outcome was defined as mRS 2 or less at 90 days. RESULTS: Overall 141 consecutively treated patients were identified. Of these, 89 (63.1%) were transferred from community hospitals for IAT. Median time from last known well to stroke center arrival was 50 mins for PD and 245 mins for TR group (T-test p<0.01). Despite this difference final infarct volume, favorable outcome and mortality rates were comparable between the groups (see table). Multivariate logistic regression model identified lower final DWI infarct volume (OR 0.97, 95%CI 0.95-0.99, p<0.01) and low presentation NIHSS (OR 0.85, 95% CI 0.73-0.99, p=0.04) as predictors of favorable outcome. CONCLUSION: Our results indicate that patients with favorable baseline head CT, referred from outlying facilities, may achieve similar clinical outcomes following IAT when compared to those presenting directly to a designated stroke center. Further randomized studies on an intent to treat design are needed to corroborate these findings.