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Original research
Futile inter-hospital transfer for mechanical thrombectomy in a semi-rural context: analysis of a 6-year prospective registry
  1. Denis Sablot1,2,
  2. Adrian Dumitrana1,
  3. Franck Leibinger3,
  4. Khaled Khlifa4,
  5. Bénédicte Fadat1,
  6. Geoffroy Farouil5,
  7. Thibaut Allou1,
  8. Francis Coll4,
  9. Julie Mas1,
  10. Philippe Smadja5,
  11. Adelaïde Ferraro-Allou1,
  12. Isabelle Mourand6,
  13. Anaïs Dutray1,
  14. Maxime Tardieu5,
  15. Snejana Jurici1,
  16. Jean-Marie Bonnec4,
  17. Nadège Olivier1,
  18. Sandra Cardini5,
  19. Frédérique Damon4,
  20. Laurène Van Damme1,
  21. Sabine Aptel5,
  22. Nicolas Gaillard1,6,
  23. Ana-Maria Marquez5,
  24. Ludovic Nguyen Them1,
  25. Majo Ibanez1,
  26. Caroline Arquizan6,
  27. Vincent Costalat7,
  28. Alain Bonafe5,7
  1. 1Neurology Department, Perpignan, France
  2. 2Regional Health Agency of Occitanie, Montpellier, France
  3. 3Intensive Care Unit, Perpignan, France
  4. 4Emergency Department, Perpignan, France
  5. 5Radiology Department, Perpignan, France
  6. 6Neurology Department, Montpellier, France
  7. 7Neuroradiology Department, Montpellier, France
  1. Correspondence to Dr Denis Sablot, Centre Hospitalier de Perpignan, Perpignan 66046, France; denis.sablot{at}ch-perpignan.fr

Abstract

Background and purpose Inter-hospital transfer for mechanical thrombectomy (MT) might result in the transfer of patients who finally will not undergo MT (ie, futile transfers [FT]). This study evaluated FT frequency in a primary stroke center (PSC) in a semi-rural area and at 156 km from the comprehensive stroke center (CSC).

Methodology Retrospective analysis of data collected in a 6-year prospective registry concerning patients admitted to our PSC within 4.5 hours of acute ischemic stroke (AIS) symptom onset, with MR angiography indicating the presence of large vessel occlusion (LVO) without large cerebral infarction (DWI-ASPECT ≥5), and selected for transfer to the CSC to undergo MT. Futile transfer rate and reasons were determined, and the relevant time measures recorded.

Results Among the 529 patients screened for MT, 278 (52.6%) were transferred to the CSC. Futile transfer rate was 45% (n=125/278) and the three main reasons for FT were: clinical improvement and reperfusion on MRI on arrival at the CSC (58.4% of FT); clinical worsening and/or infarct growth (16.8%); and longer than expected inter-hospital transfer time (11.2%). Predictive factors of FT due to clinical improvement/reperfusion on MRI could not be identified. Baseline higher NIHSS (21 vs 17; P=0.01) and lower DWI-ASPECT score (5 vs 7; P=0.001) were associated with FT due to clinical worsening/infarct growth on MRI.

Conclusions In our setting, 45% of transfers for MT were futile. None of the baseline factors could predict FT, but the initial symptom severity was associated with FT caused byclinical worsening/infarct growth.

  • stroke
  • thrombectomy

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Footnotes

  • Contributors DS, GF: conception and design of the work, data collection, analysis, interpretation of data, drafting, writing, and final approval. AD: conception and design of the work, data collection, analysis, interpretation of data, drafting, and writing. FL, AB: conception and design of the work, analysis, interpretation of data, drafting, writing, and final approval. KK: data collection, statistical analysis, interpretation of data, drafting, and final approval. BF, TA, FC, JM, PS, AF-A, AD, MT, SJ, J-MB, NO, SC, FD, LVD, SA, NG, AMM, LN-T, M-JI: data collection, analysis, interpretation of data, drafting, and final approval. IM: interpretation of data, drafting, and final approval. CA, VC: analysis, interpretation of data, drafting, writing, and final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

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

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