Introduction Endovascular mechanical thrombectomy has become the standard of care for patients presenting with a large vessel occlusion of the intracranial circulation and has saved many patients from long term disability and death each year.¹. Many strokes patients are transferred to the closest community stroke hospital before being transferred to a Comprehensive stroke center with endovascular therapy. A recent analysis revealed significant improvement in clinical outcome in the group of patients brought directly to an endovascular capable hospital compared to patients transferred from a primary stroke center.² This study sought to determine if the same benefit held true for patients who bypassed their local stroke center and were brought directly to a comprehensive stroke center(CSC) compared to patients who went to a local stroke center and then were transferred to the CSC.

Methods Mechanical thrombectomies performed in 2019 were retrospectively analyzed. EMS records were analyzed to determine if the decision was made to bypass a local stroke center to bring the patient directly to AMC. 90 day mRS was extracted by phone call or office visit by trained staff. Statistical analysis was performed by logistic regression of mRs outcome scores as a function of bypass vs transfer status.

Results A total of 98 thrombectomies were performed on patients who were brought to the hospital by EMS. 17 patients were identified as having bypassed a local primary stroke center to come directly to the CSC. 36 patients were transferred from a primary local stroke center. An excellent outcome(mRS) was more likely in patients who bypassed a local primary stroke center compared to patients who first went to a local primary stroke center and were subsequently transferred to the CSC(58.8% versus 27.8%, p=0.04). There was no difference in mortality(29.4% versus 44.4%, p=0.37).

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Abstract E-060 Figure 1

Discussion Patients who bypass their local stroke center and are brought directly to a CSC are more likely to have an excellent outcome compared to patients who first stop at the local stroke center and are subsequently transferred to the CSC.

References

1. Saver J, et al. SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–2295. doi: 10.1056/NEJMoa1415061

2. Froehler MT: Interhospital transfer before thrombectomy is associated with delayed treatment and worse outcome in the STRATIS registry. Circulation 2017;136:2311–2321. https://doi.org/10.1161/CIRCULATIONAHA.117.028920

Disclosures A. Paul: None. J. MacDonell: None. N. Field: None. P. Entezami: None. J. Dalfino: None. A. Boulos: None.