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

Meenen, Laura C. C. van; Hartog, Sanne J. den; Groot, Adrien E.; Emmer, Bart J.; Smeekes, Martin; Siegers, Arjen; Kommer, Geert Jan; Majoie, Charles B. L. M.; Roos, Yvo B.W.E.M.; Es, Adriaan C.G.M. van; Dippel, Diederik W.J.; Worp, H. Bart van der; Lingsma, Hester F.; Roozenbeek, Bob; Coutinho, Jonathan M.

doi:10.1111/ene.15107

Cited by 6 publications

(7 citation statements)

References 34 publications

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“…14 In the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN) registry, 42% of EVT cases initially presented to a PSC, with a median time from stroke onset to arrival at the PSC of 53 minutes and 83% of them receiving IV thrombolysis. 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.…”

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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Section: Discussionmentioning

confidence: 99%

IV Thrombolysis Initiated Before Transfer for Endovascular Stroke Thrombectomy

et al. 2023

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“…In the Netherlands, the country in which the groundbreaking MR CLEAN trial was conducted [8] there may be little room EDITORIAL median ambulance travel time was 19 min [5] which was remarkably short. Within such a well-organized system, it may be more difficult to discern potential effect-modifying variables, as the authors rightly state.…”

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confidence: 99%

“…Moreover, the Netherlands is a densely populated country. The median ambulance travel time was 19 min [5] which was remarkably short. Within such a well‐organized system, it may be more difficult to discern potential effect‐modifying variables, as the authors rightly state.…”

mentioning

confidence: 99%

“…In this issue of the European Journal of Neurology , van Meenen et al [5] focus on inter‐hospital transfer and the effect of the volume of referred patients (from PSC to CSC) on treatment times and functional outcomes. With respect to EVT, procedural volume and patient outcomes are related [6].…”

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confidence: 99%

“…One would expect high‐volume PSCs to outperform low‐volume PSCs. Interestingly, and unexpectedly, EVT referral volume was not associated with PSCS‐door‐to‐groin time, CSC‐door‐to‐groin time nor 90‐day modified Rankin Scale score in this nationwide analysis [5].…”

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confidence: 99%

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Efficiency of stroke networks for referral of mechanical thrombectomy: The more the better?

Nolte

Nguyen

2021

Euro J of Neurology

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Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: A prospective cohort study

Freixa-Cruz,

Jimenez-Jimenez,

Mauri-Capdevila

et al. 2023

Preprint

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Background and rationale Evaluating scales to detect large vessel occlusion (LVO) could aid in considering early referrals to a thrombectomy-capable center in the prehospital stroke code setting. Nevertheless, they entail a significant number of false positives, corresponding to intracranial hemorrhages (ICH), which could result in a delay in medical attention and potential harm. Our study aims to identify easily collectible variables for the development of a scale to differentiate patients with ICH from LVO in a prehospital context. Methods We conducted a prospective cohort study of stroke code patients between May 2021 and January 2023. Patients were evaluated with CT/CT-Angiography at arrival. We compared clinical variables and vascular risk factors between ICH and LVO patients to design a prehospital ICH screening scale (PreICH). Results Out of 989 stroke code patients, we included 190 (66.7%) LVO cases and 95 (33.3) ICH cases. In the multivariate analysis, headache (odds ratio [OR] 3.56; 1.50-8.43), GCS<8 (OR 8.19; 3.17-21.13), SBP>160mmHg (OR 6.43; 3.37-12.26) and male sex (OR 2.07; 1.13- 3.80) were associated with ICH, while previous hypercholesterolemia (HCL) (OR 0.35; 0.19-0.65) with LVO. The scale design was conducted, assigning a score to each significant variable based on its specific weight: +2 points for SBP > 160, +1 points for headache, +1 points for male sex, +2 points for GCS<8, and -1 points for HCL. The area under the curve (AUC) was 0.82 (0.77-0.87). A score ?4 exhibited a sensitivity of 0.10, a specificity of 0.99, a positive predictive value of 0.21, and a negative predictive value of 0.98 . Conclusion We present the development of a prehospital scale to discriminate between ICH and LVO patients, utilizing easily detectable variables in the prehospital setting.

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

Cited by 6 publications

References 34 publications

IV Thrombolysis Initiated Before Transfer for Endovascular Stroke Thrombectomy

IV Thrombolysis Initiated Before Transfer for Endovascular Stroke Thrombectomy

Efficiency of stroke networks for referral of mechanical thrombectomy: The more the better?

Prehospital scale to differentiate intracerebral hemorrhage from large-vessel occlusion patients: A prospective cohort study

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