Pre- and Interhospital Workflow Times for Patients With Large Vessel Occlusion Stroke Transferred for Endovasvular Thrombectomy

Meenen, Laura C. C. van; Riedijk, Frank; Stolp, Jeffrey; Veen, Bas van der; Halkes, Patricia H.A.; Ree, Taco C van der; Majoie, Charles B. L. M.; Roos, Yvo B.W.E.M.; Smeekes, Martin; Coutinho, Jonathan M.

doi:10.3389/fneur.2021.730250

Cited by 6 publications

(6 citation statements)

References 27 publications

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“…We made a conscious choice to censor data at the 240‐minute mark, as we wanted to ensure that an adequate sample size was present at each time epoch to ensure model accuracy. Although this limits our understanding of thrombolytic‐induced reperfusion differences between tenecteplase and alteplase in patients with prolonged lytic to reperfusion assessment times, prior workflow studies of interhospital transfers for endovascular therapy‐eligible patients have largely reported transfer times ranging from 20 to 300 minutes 26–28 . As such, we feel that our model is representative of patients in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Tenecteplase Improves Reperfusion across Time in Large Vessel Stroke

Yogendrakumar

Beharry

Чурилов

et al. 2022

Annals of Neurology

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Objective Tenecteplase improves reperfusion compared to alteplase in patients with large vessel occlusions. To determine whether this improvement varies across the spectrum of thrombolytic agent to reperfusion assessment times, we performed a comparative analysis of tenecteplase and alteplase reperfusion rates. Methods Patients with large vessel occlusion and treatment with thrombolysis were pooled from the Melbourne Stroke Registry, and the EXTEND‐IA and EXTEND‐IA TNK trials. The primary outcome, thrombolytic‐induced reperfusion, was defined as the absence of retrievable thrombus or >50% reperfusion at imaging reassessment. We compared the treatment effect of tenecteplase and alteplase, accounting for thrombolytic to assessment exposure times, via Poisson modeling. We compared 90‐day outcomes of patients who achieved reperfusion with a thrombolytic to patients who achieved reperfusion via endovascular therapy using ordinal logistic regression. Results Among 893 patients included in the primary analysis, thrombolytic‐induced reperfusion was observed in 184 (21%) patients. Tenecteplase was associated with higher rates of reperfusion (adjusted incidence rate ratio [aIRR] = 1.50, 95% confidence interval [CI] = 1.09–2.07, p = 0.01). Findings were consistent in patient subgroups with first segment (aIRR = 1.41, 95% CI = 0.93–2.14) and second segment (aIRR = 2.07, 95% CI = 0.98–4.37) middle cerebral artery occlusions. Increased thrombolytic to reperfusion assessment times were associated with reperfusion (tenecteplase: adjusted risk ratio [aRR] = 1.08 per 15 minutes, 95% CI = 1.04–1.13 vs alteplase: aRR = 1.06 per 15 minutes, 95% CI = 1.00–1.13). No significant treatment‐by‐time interaction was observed (p = 0.87). Reperfusion via thrombolysis was associated with improved 90‐day modified Rankin Scale scores (adjusted common odds ratio = 2.15, 95% CI = 1.54–3.01) compared to patients who achieved reperfusion following endovascular therapy. Interpretation Tenecteplase, compared to alteplase, increases prethrombectomy reperfusion, regardless of the time from administration to reperfusion assessment. Prethrombectomy reperfusion is associated with better clinical outcomes. ANN NEUROL 2023;93:489–499

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Section: Discussionmentioning

confidence: 99%

Tenecteplase Improves Reperfusion across Time in Large Vessel Stroke

Yogendrakumar

Beharry

Чурилов

et al. 2022

Annals of Neurology

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“…29 Based on data from the same registry, the respective median time between PSC arrival and dispatch (door-in – door-out) was 85 minutes, whereas the median transfer time from the PSC to the CSC was 28 minutes. 30 Onset-to-treatment time is known to correlate not only with the elapsed time between IV thrombolysis bolus and recanalization but also with the probability of 3-month favorable functional outcomes. 31 Patients with acute ischemic stroke receiving IV thrombolysis within 60 minutes from symptoms onset, also referred as the golden hour, have substantially higher odds of early neurologic recovery, successful recanalization, and favorable 3-month functional outcomes.…”

Section: Discussionmentioning

confidence: 99%

IV Thrombolysis Initiated Before Transfer for Endovascular Stroke Thrombectomy

et al. 2023

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Background and objective:The role of intravenous thrombolysis (IVT) in patients with large vessel occlusions (LVOs)administered prior to transferfrom a primary stroke center (PCS) to a comprehensive stroke center (CSC) is questioned.Methods:We included observational studies of patients with an LVO receiving IVT at a PCS prior to their EVT transfer compared to those receiving EVT alone. Efficacy outcomes included excellent or good functional outcomes [modified Rankin Scale (mRS) scores of 0-1or0-2, respectively] and reduced disability (mRS shift analysis) at three months. Safety outcomes included symptomatic intracranial hemorrhage (sICH) within 48 hours andthree-monthall-cause mortality. Associations are reported with crude odds ratios (ORs) and adjusted ORs (aOR).Results:We identified 6 studies, including 1723 participants (mean age: 71 years, 51% women; 53% treated with IVT at a PSC). The mean onset-to-groin puncture time did not differ between the two groups (mean difference:-20 min, 95%CI:-115.89,76.04). Patients receiving IVT prior to transfer had higher odds of three-month reduced disability (common OR=1.98; 95%CI:1.17-3.35), excellent (OR=1.70,95%CI:1.28-2.26) and good (OR=1.62,95%CI:1.15-2.29) functional outcomes, with no increased sICH (OR=0.87,95%CI:0.54-1.39) or mortality (OR=0.55,95%CI:0.37-0.83) risks. In the adjusted analyses patients receiving IVT at a PSC had higher odds of excellent functional outcome (aOR=1.32,95%CI:1.00-1.74) and lower probability for mortality (aOR=0.50,95%CI:0.27-0.93).Discussion:LVO patients receiving IVT at a PSC prior to an EVT transfer have higher likelihood of excellent functional recovery and lower odds of mortality, with no increase in sICH and onset-to-groin puncture times, compared tothose transferred for EVT without previously receiving IVT.

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“…Another potential explanation for the absence of an association between PSC volume and treatment times in our study could be the fact that the Netherlands has a well‐developed health care system. Stroke workflow in the Netherlands, including emergency medical services and PSC and CSC logistics, is generally well organized, resulting in relatively short treatment times [ 19] . Within such a system it may be more difficult to discern the potential effect modifying variables such as PSC volume.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who had primarily presented to a CSC or to a PSC outside the Netherlands were excluded from the analysis. Furthermore, because during the study period EVT was not standard care in the Netherlands for patients with a large‐vessel occlusion stroke who were presented more than 6 h after onset, and median door‐to‐groin time in patients transferred for EVT in the Netherlands is approximately 30 min[ 19] , we excluded patients with an onset‐to‐groin time >390 min. In‐hospital strokes were also excluded.…”

Section: Methodsmentioning

confidence: 99%

Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

Meenen

Hartog

Groot

et al. 2021

Euro J of Neurology

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Background and purpose:We investigated whether the annual volume of patients with acute ischemic stroke referred from a primary stroke center (PSC) for endovascular treatment (EVT) is associated with treatment times and functional outcome. Methods:We used data from the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) registry (2014)(2015)(2016)(2017). We included patients with acute ischemic stroke of the anterior circulation who were transferred from a PSC to a comprehensive stroke center (CSC) for EVT. We examined the association between EVT referral volume of PSCs and treatment times and functional outcome using multivariable regression modeling. The main outcomes were time from arrival at the PSC to groin puncture (PSC-door-to-groin time), adjusted for estimated ambulance travel times, time from arrival at the CSC to groin puncture (CSC-doorto-groin time), and modified Rankin Scale (mRS) score at 90 days after stroke. Results: Of the 3637 patients in the registry, 1541 patients (42%) from 65 PSCs were included. Mean age was 71 years (SD ± 13.3), median National Institutes of Health Stroke Scale score was 16 (interquartile range [IQR]: 12-19), and median time from stroke onset to arrival at the PSC was 53 min (IQR: 38-90). Eighty-three percent had received intravenous

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Pre- and Interhospital Workflow Times for Patients With Large Vessel Occlusion Stroke Transferred for Endovasvular Thrombectomy

Cited by 6 publications

References 27 publications

Tenecteplase Improves Reperfusion across Time in Large Vessel Stroke

Tenecteplase Improves Reperfusion across Time in Large Vessel Stroke

IV Thrombolysis Initiated Before Transfer for Endovascular Stroke Thrombectomy

Relationship between primary stroke center volume and time to endovascular thrombectomy in acute ischemic stroke

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