Background: New generation IA devices are highly effective; however, it is unclear if transfer patients derive similar benefit given the treatment delay intrinsic to this approach. Our aim was to determine the potential eligibility and efficacy of CT perfusion (CTP) guided IA therapy in transferred patients.
Methods: All transferred and stent retriever treated ischemic stroke patients selected using CTP between 5/12 -1/15 were included. Baseline demographics including age, NIHSS, IV tPA use, and time points pertinent to CTP imaging and IA procedures were collected. Primary outcome was 90d mRS. Secondary endpoints included successful reperfusion and mortality. Primary safety endpoint was symptomatic ICH (sICH) rate.
Results: Overall 401 transferred patients were potentially eligible and 22% were treated (n=90). Median age was 70 and median NIHSS 14.5 (SD 6.8). Average remote site distance was 90 (range 1- 356) miles. 73% received IV tPA. Median time of onset to reperfusion was 530 min. Median onset to CTP time was 323 min. Median CTP to groin puncture 138 min and median CTP time to reperfusion 197 min. TICI 2B or 3 reperfusion was achieved in 80%. 84 patients had 90d outcome data. Favorable outcome (mRS of 0-2) was achieved in 64%. sICH rate was 4.4%. 90d mortality was 11%.
Conclusions: Outcomes in transferred CTP guided IA stroke therapy patients were similar to clinical trials despite onset to treatment times at least 80% longer than in recently reported studies, strongly supporting this approach. A substantial proportion of transfer patients can receive successful IA therapy using modern imaging techniques and treatments.