Introduction: Clinical trials confirmed the benefits of intra-arterial therapy (IAT) for managing acute ischemic stroke (AIS). Yet not all hospitals are able to perform IAT, requiring rapid transfer of potential IAT candidates.
Hypothesis: AIS patients receiving IAT who were admitted directly to a Comprehensive Stroke Center (CSC) would have similar outcomes to those transferred to the CSC from a less specialized hospital.
Methods: Data were retrospectively abstracted for AIS patients treated with IAT at a CSC (1/2014 – 5/2015). Clinical characteristics and the following outcomes were compared in patients directly admitted to the CSC and those transferred: recanalization to TICI ≥2b, discharge and 90-day mRS (favorable, ≤2), sICH, and in-hospital mortality. Univariate and multiple logistic regression analyses were conducted.
Results: IAT was performed in 133 patients; 34 (25.6%) directly admitted and 99 (74.4%) transferred to the CSC. Transferred patients were significantly younger, more often male, with fewer comorbidities, a longer time from symptom onset to arrival, but shorter time from arrival to groin puncture (table 1). Unadjusted outcomes were similar between groups (table 1). After adjusting for significant covariates (p<0.05), transferred patients were 89% less likely to have a favorable discharge mRS (OR=0.14 (0.02-0.47), p=0.003) than directly admitted patients. Transfers had a borderline worse 90-day mRS (p=0.07); no difference was observed between groups for the remaining outcomes (p>0.4 for all). Discharge mRS remained worse in transferred patients (p=0.01) after limiting the data to those arriving to the CSC <6 hours after symptom onset.
Conclusion: Even after limiting the analysis to patients arriving to the CSC <6 hours after symptom onset, directly admitted IAT patients had more favorable outcomes than transferred IAT patients. This suggests select, potential IAT candidates, may benefit from bypassing centers not able to perform IAT.