You are here

Article Text

Article menu

Download PDFPDF

XML
Ischemic Stroke
Original research
Impact of EMS bypass to endovascular capable hospitals: geospatial modeling analysis of the US STRATIS registry
  1. Nils Mueller-Kronast1,
  2. Michael T Froehler2,
  3. Reza Jahan3,
  4. Osama Zaidat4,
  5. David Liebeskind5,
  6. Jeffrey L Saver6
  7. on behalf of the STRATIS Investigators
  1. 1 Advanced Neuroscience Network/Tenet South Florida, Delray Beach, Florida, USA
  2. 2 Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  3. 3 Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
  4. 4 St Vincent Mercy Hospital, Toledo, Ohio, USA
  5. 5 Neurovascular Imaging Core and UCLA Stroke Center, Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
  6. 6 Department of Neurology, University of California Los Angeles, Los Angeles, California, USA
  1. Correspondence to Dr Nils Mueller-Kronast, Department of Neurology, Advanced Neuroscience Network/Tenet South Florida, Delray Beach, FA 33484, USA; muellerkronast{at}gmail.com

Abstract

Background Routing patients directly to endovascular capable centers (ECCs) would decrease time to mechanical thrombectomy (MT), but may delay intravenous thrombolysis (IVT).

Objective To study the clinical outcomes of patients with a stroke transferred directly to ECCs compared with those transferred to ECCs from non-endovascular capable centers (nECCs).

Methods Data from the STRATIS registry were analyzed to evaluate process and clinical outcomes under five routing policies: (1) transport to nearest nECC; (2) transport to STRATIS ECC over any distance or (3) within 20 miles; (4) transport to ideal ECC (iECC), over any distance or (5) within 20 miles.

Results Among 236 patients, 117 (49.6%) were transferred by ground, of whom 62 (53%) were transferred within 20 miles. Median MT start time was accelerated in all direct transport models. IVT start was prolonged with direct transport across all distances, but accelerated with direct transport to iECC ≤20 miles. With bypass limited to ≤20 miles, the median modeled EMS arrival to IVT interval decreased for both iECCs and ECCs (by 12 min and 6 min, respectively), and median EMS arrival to puncture time decreased by up to 94 min. In this cohort, no patient would have become ineligible for IVT. Bypass to iECC modeling under 20 miles showed a significant reduction in the level of disability at 3 months, with freedom from disability (modified Rankin Scale score 0–1) at 3 months increased by 12%.

Conclusions Direct routing of patients with a large vessel occlusion to ECCs, especially when within 20 miles, may lead to better clinical outcomes by accelerating the start of MT without any delay of IVT.

Clinical trial registration number http://www.clinicaltrials.gov. Unique identifier: NCT02239640.

  • stroke
  • thrombectomy
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/neurintsurg-2019-015593

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Collaborators Mohammad Ali Aziz-Sultan, Richard P. Klucznik, Frank R. Hellinger Jr, Dileep R. Yavagal, Tom L. Yao, Ashutosh P. Jadhav, Rishi Gupta, Ameer E. Hassan, Coleman O. Martin, Hormozd Bozorgchami, Ritesh Kaushal, Raul G. Nogueira, Ravi H. Gandhi, Eric C. Peterson, Shervin R. Dashti, Curtis A. Given II, Brijesh P. Mehta, Vivek Deshmukh, Sidney Starkman, Italo Linfante, Scott H. McPherson, Peter Kvamme, Thomas J. Grobelny, Muhammad S. Hussain, Ike Thacker, Nirav Vora, Peng Roc Chen, Stephen J. Monteith, Robert D. Ecker, Clemens M. Schirmer, Eric Sauvageau, Alex Abou-Chebl, Colin P. Derdeyn, Lucian Maidan, Aamir Badruddin, Adnan H. Siddiqui, Travis M. Dumont, Abdulnasser Alhajeri, M. Asif Taqi, Khaled Asi, Jeffrey Carpenter, Alan Boulos, Gaurav Jindal, Ajit S. Puri, Rohan Chitale, Eric M. Deshaies, David H. Robinson, David F. Kallmes, Blaise W. Baxter, Mouhammad A. Jumaa, Peter Sunenshine, Aniel Majjhoo, Joey D. English, Shuichi Suzuki, Richard D. Fessler, Josser E. Delgado Almandoz, Jerry C. Martin, Diogo C. Haussen

    • Contributors All authors made substantial contributions to the conception and design, analysis, and interpretation of data; drafted or critically revised the article; and gave final approval of the version to be published.

    • Funding This study was sponsored by Medtronic, Inc.

    • Competing interests NM-K and OZ serve as scientific consultants regarding trial design and conduct to Medtronic, who sponsored this study. MTF serves as a scientific consultant to Medtronic, Stryker, Balt, Viz.ai, NeurVana, and Genentech, and has received research funding from the National Institutes of Health (NIH), Stryker, Medtronic, Microvention, and Endophys. The University of California, Regents receives funding for Dr Jahan’s services as a scientific consultant regarding trial design and conduct to Medtronic/Covidien; RJ is an employee of the University of California, which holds a patent on retriever devices for stroke. The University of California, Regents receives funding for Dr Saver’s services as a scientific consultant regarding trial design and conduct to Covidien and Stryker; JLS is an employee of the University of California, which holds a patent on retriever devices for stroke. DL serves as an imaging core laboratory consultant for Cerenovus, Genentech, Medtronic, Stryker, and Vesalio.

    • Patient consent for publication Not required.

    • Ethics approval The study was performed in compliance with the World Medical Association's Declaration of Helsinki. The study protocol was approved by the local ethics committee.

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

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.