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Original research
Referral facility CT perfusion prior to inter-facility transfer in patients undergoing mechanical thrombectomy
  1. Amin Aghaebrahim,
  2. Eric Sauvageau,
  3. Pedro Aguilar-Salinas,
  4. Gustavo Cortez,
  5. Roberta Santos,
  6. Ricardo A Hanel
  1. Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida, USA
  1. Correspondence to Dr Amin Aghaebrahim, 800 Prudential Drive, Tower B 11TH Floor, Jacksonville, FL 32207, USA; amin.aghaebrahim{at}


Background and purpose The use of CT perfusion (CTP) imaging at a referring hospital is feasible and may shorten the door to puncture time for patients with acute ischemic stroke.

Methods We conducted a single center retrospective review of a prospectively maintained database of consecutive ischemic stroke patients transferred to our center for consideration of endovascular therapy. Patients were divided into two groups. Group 1 consisted of patients transferred from facilities where CTP (using automated RAPID software) was routinely performed and group 2 consisted of patients transferred from facilities that did not perform perfusion imaging.

Results We identified a total of 132 patients, all of whom were transferred to our center, from April 2014 to April 2017. There were no differences in baseline characteristics between the two groups. A total of 34 patients were transferred from a facility after CTP (group 1) and 98 were transferred from a facility with no CTP (group 2). Door to puncture time was significantly shorter for patients in group 1 compared with those in group 2 (median 12 (IQR 8–16) min and 48.5 (32.8–71.8) min, respectively; P<0.001). Despite obtaining additional pre-transfer imaging in group 1, there was no difference in door in and door out times at the referring facilities compared with group 2.

Conclusions We found that triaging from a primary stroke center after CTP RAPID was feasible and significantly reduced the door to puncture time without any significant delay in the transfer process.

  • brain
  • stroke
  • Ct perfusion
  • thrombectomy

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  • Contributors AA and PA-S were responsible for the study concept and design. PA-S, GC, and RS contributed to acquisition of the data. All authors were responsible for analysis and interpretation of the data. All authors contributed to drafting of the manuscript. AA, ES, and RH contributed to critical revision of the manuscript for important intellectual content. All authors were responsible for administrative, technical, and material support. AA, ES, and RH contributed to study supervision.

  • Competing interests RH is a consultant for Covidien, Stryker, Codman, and MicroVention.

  • Ethics approval Institutional review board approval (institutional review board of Baptist Health, #16-58) and HIPAA waiver were obtained because of the retrospective nature of the study.

  • Provenance and peer review Not commissioned; externally peer reviewed.